Provider Demographics
NPI:1043557333
Name:FREELAND PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:FREELAND PRIMARY CARE PLLC
Other - Org Name:SOUTH ISLAND PRIMARY AND IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-929-4936
Mailing Address - Street 1:3145 SHADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-9031
Mailing Address - Country:US
Mailing Address - Phone:360-929-4936
Mailing Address - Fax:
Practice Address - Street 1:1690 LAYTON RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-9456
Practice Address - Country:US
Practice Address - Phone:360-678-6576
Practice Address - Fax:360-678-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60126180261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center