Provider Demographics
NPI:1073502829
Name:FREEMAN, RUTH A (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:A
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 201ST PL SE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8572
Mailing Address - Country:US
Mailing Address - Phone:425-219-4720
Mailing Address - Fax:425-949-7059
Practice Address - Street 1:1908 201ST PL SE STE 100
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-8572
Practice Address - Country:US
Practice Address - Phone:425-219-4720
Practice Address - Fax:425-949-7059
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8234890Medicaid
WAG20702Medicare UPIN
WAAB34917Medicare ID - Type Unspecified