Provider Demographics
NPI:1235120353
Name:FREEDMAN, KENN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENN
Middle Name:ALAN
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:2A100
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-2020
Practice Address - Fax:806-743-1782
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8052207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX64022OtherPRESBYTERIAN COMMERCIAL
TX113026102Medicaid
NM64022Medicaid
TX84332ZOtherHMO BLUE
TX86941XOtherBC/BS
NMB3415Medicaid
TX100890602Medicaid
TX113026100OtherFIRSTCARE COMMERCIAL
TX100890601Medicaid
OK100211700AMedicaid
NME002OtherTRIWEST
TX100890602Medicaid
TX113026100OtherFIRSTCARE COMMERCIAL
TXF64460Medicare UPIN