Provider Demographics
NPI:1033273503
Name:PETERS, FREEMAN
Entity Type:Individual
Prefix:MR
First Name:FREEMAN
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DONS WAY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-620-5130
Mailing Address - Fax:501-620-5203
Practice Address - Street 1:1615 MARTIN LUTHER KING BLVD.
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104
Practice Address - Country:US
Practice Address - Phone:501-332-5236
Practice Address - Fax:501-332-8534
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator