Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 04-14433 | KS |
NPI | 1033109830 |
---|---|
Provider Name | Fred A Freeman |
First Address | Manhattan, KS 66502-2770 |
Second Address | Manhattan, KS 66502-2770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 02/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B91004 | (02) |