Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | A25347 | CA |
Y | 207Q00000X | Family Doctor | A25347 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | A25347 | CA |
NPI | 1871629568 |
---|---|
Provider Name | Dr. Larry Allan Freeman |
First Address | Palo Alto, CA 94306-4084 |
Second Address | Palo Alto, CA 94306-4084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 10/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A24394 | (02) | CA |
A25347 | CA MEDICAL LICENSE # (01) | CA |