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Organization
MARK FREEMAN, MD
Active
Organization
MARK FREEMAN, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK FREEMAN MD (CEO)
(707) 995-1362
Entity
Organization
Contact information
Practice address
15322 LAKESHORE DR, SUITE 101, CLEARLAKE, CA 95422-9814
(707) 995-1362
(707) 995-7057
Mailing address
15322 LAKESHORE DR, SUITE 101, CLEARLAKE, CA 95422-9814
(707) 995-1362
(707) 995-7057
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G47688
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G476880
—
CA
01
—
080150278
MEDICARE RAILROAD #
—
Enumeration date
10/25/2006
Last updated
04/17/2009
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