Organization
DONALD S FREEDMAN MD PA
Active
Other names
Northside Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARON MINGER WILSON MGR (OFFICE ADMINISTRATOR)
(904) 764-5000
Entity
Organization
Contact information
Practice address
480 BUSCH DR, JACKSONVILLE, FL 32218-5553
(904) 764-5000
Mailing address
480 BUSCH DR, JACKSONVILLE, FL 32218-5553
(904) 764-5000
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
ME 31964
FL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
OS58811
FL
207V00000X
Obstetrics & Gynecology Physician
ME31964
FL
208D00000X
General Practice Physician
Primary
ME49644
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62840
BLUE SHIELD OF FLORIDA
FL
Enumeration date
10/23/2007
Last updated
04/01/2008
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