1336210707 NPI number — DR. GARY FREEDMAN, M.D. GARY FREEDMAN, M.D.

Table of content: DR. GARY FREEDMAN, M.D. GARY FREEDMAN, M.D. (NPI 1336210707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336210707 NPI number — DR. GARY FREEDMAN, M.D. GARY FREEDMAN, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEDMAN, M.D.
Provider First Name:
GARY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
GARY FREEDMAN, M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336210707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3530 LAS PASAS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95864-2820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-435-4751
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MITZPE NETOFA
Provider Second Line Business Practice Location Address:
1137
Provider Business Practice Location Address City Name:
D.N. LOWER GALILEE
Provider Business Practice Location Address State Name:
GALIL
Provider Business Practice Location Address Postal Code:
15295
Provider Business Practice Location Address Country Code:
IL
Provider Business Practice Location Address Telephone Number:
046789215
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  A41220 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)