1821163650 NPI number — DR. MAYRA LOUISE FREEMAN-LADD MD

Table of content: WILLIAM JACOB THOMAS M.D. (NPI 1124554712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821163650 NPI number — DR. MAYRA LOUISE FREEMAN-LADD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN-LADD
Provider First Name:
MAYRA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREEMAN
Provider Other First Name:
MAYRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821163650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 W 30TH AVE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
PAMPA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79065-2814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-663-5654
Provider Business Mailing Address Fax Number:
806-663-5642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W 30TH AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
PAMPA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79065-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-663-5654
Provider Business Practice Location Address Fax Number:
806-663-5642
Provider Enumeration Date:
11/20/2006

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: 2080N0001X , with the licence number:  ME78103 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: N5057 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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