Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | ME71863 | FL |
NPI | 1316969660 |
---|---|
Provider Name | Dr. Michael Lawrence Freeman |
First Address | Jacksonville, FL 32207-8336 |
Second Address | Daytona Beach, FL 32114-2730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 16/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H03774 | (02) | FL |