Individual
DERRICK BRENT FREEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1441 FLORIDA AVE, MODESTO, CA 95350-4404
(209) 578-1211
Mailing address
2020 LARRY PL, LIVERMORE, CA 94550-6469
(925) 784-3453
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
54664
CA
Other
Enumeration date
07/24/2017
Last updated
07/24/2017
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