MEDICARE: TIJUANA LISETTE FREEMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	15040	MS
2	208000000X	Pediatrics Physician	E-1828	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1832000000	OTHER	AR	QUAL CHOICE
3	1222017	OTHER	AR	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1952366080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIJUANA LISETTE FREEMAN M.D.

Provider Business Mailing Address
First Line	:	3650 GROVELAND RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5753
Country	:	US
Telephone Number	:	228-875-0780
Fax Number	:	228-875-1009

Provider Business Practice Location Address
First Line	:	3650 GROVELAND RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5753
Country	:	US
Telephone Number	:	228-875-0780
Fax Number	:	228-875-1009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	12/29/2011

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Directions to “ TIJUANA LISETTE FREEMAN M.D.” Practice Location

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