Provider Demographics
NPI:1124194568
Name:GEORGE EDWARD FREEMAN, D.O.,P.C.
Entity Type:Organization
Organization Name:GEORGE EDWARD FREEMAN, D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-286-4949
Mailing Address - Street 1:1425 E LINCOLN RD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7345
Mailing Address - Country:US
Mailing Address - Phone:580-286-4949
Mailing Address - Fax:580-286-4946
Practice Address - Street 1:1425 E LINCOLN RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7345
Practice Address - Country:US
Practice Address - Phone:580-286-4949
Practice Address - Fax:580-286-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3192207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100253460AMedicaid
OK442682988PMedicare ID - Type UnspecifiedMEDICARE
OK100253460AMedicaid