Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 15218 | NH |
Y | 208200000X | Surgeon | 15218 | NH |
Y | 208600000X | Surgeon | 15218 | NH |
NPI | 1023284148 |
---|---|
Provider Name | Dr. Gary Leland Freed JR. |
First Address | Lebanon, NH 03756-1000 |
Second Address | Lebanon, NH 03756-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2008 |
Last Update Date | 22/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1019432 | (05) | VT |
110090698A | (05) | MA |
32000757 | (05) | NH |