Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 15151 | TX |
NPI | 1154431427 |
---|---|
Provider Name | Kim Freeman |
First Address | Lake Jackson, TX 77566 |
Second Address | Lake Jackson, TX 77566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |