Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 127507 | NY |
Y | 111NI0900X | Internist | 127507 | NY |
N | 207RH0002X | Hospice and Palliative Medicine | 127507 | NY |
NPI | 1154393015 |
---|---|
Provider Name | Jack P Freer |
First Address | Buffalo, NY 14216-2611 |
Second Address | Buffalo, NY 14216-2611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 11/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B36092 | (02) |