Provider Demographics
NPI:1194838409
Name:FREEMAN, GEORGEANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGEANNE
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 W. 5TH STREET
Mailing Address - Street 2:SUITE 180
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4891
Mailing Address - Country:US
Mailing Address - Phone:512-391-9400
Mailing Address - Fax:512-391-9401
Practice Address - Street 1:1611 W. 5TH STREET
Practice Address - Street 2:SUITE 180
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4891
Practice Address - Country:US
Practice Address - Phone:512-391-9400
Practice Address - Fax:512-391-9401
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1194838409Medicaid
MOP00724821OtherRAILROAD MEDICARE
11820416OtherCAQH PROVIDER #
431560263OtherTRICARE WEST
431560263OtherTRICARE WEST
MO1194838409Medicaid
TXTXB143344Medicare PIN