Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 21057 | AL |
NPI | 1003855560 |
---|---|
Provider Name | Dr. Lucius Bedford Freeman |
First Address | Prattville, AL 36066-7268 |
Second Address | Prattville, AL 36066-7268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 06/03/2019 |