Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 5254 | TX |
NPI | 1447268040 |
---|---|
Provider Name | Richard Curtis Freeze III |
First Address | Amarillo, TX 79109-3439 |
Second Address | Amarillo, TX 79109-3439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
603184 | BCBS (01) | TX |