Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 26713 | MN |
NPI | 1013955848 |
---|---|
Provider Name | Martin L Freeman |
First Address | Minneapolis, MN 55414-2924 |
Second Address | Minneapolis, MN 55404-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 18/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
973077000 | (05) | MN |
A94773 | (02) |