Provider Demographics
NPI:1164743720
Name:FREEMAN, BRIAN LARRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LARRY
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:780 SWIFT BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3524
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:1100 GOETHALS DRIVE 2ND FLOOR
Practice Address - Street 2:KADLEC CLINIC FOOT & ANKLE
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3304
Practice Address - Country:US
Practice Address - Phone:509-942-3627
Practice Address - Fax:509-547-0827
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60337485213E00000X
OH213ES0103X213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500657140Medicaid
WA0312593OtherL&I
WA1164743720Medicaid
WAG8919670Medicare PIN