Provider Demographics
NPI:1164459434
Name:FREEMAN, MITCH (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCH
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:M
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:PO BOX 6497
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2521
Mailing Address - Country:US
Mailing Address - Phone:928-314-1695
Mailing Address - Fax:928-314-1696
Practice Address - Street 1:2120 W 24TH ST STE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6122
Practice Address - Country:US
Practice Address - Phone:928-314-1695
Practice Address - Fax:928-314-1696
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ476003Medicaid
AZ29394Medicare PIN
AZG84962Medicare UPIN
CA27545Medicare PIN