Provider Demographics
NPI:1235163890
Name:FREEMAN, EARL R JR (DO)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:R
Last Name:FREEMAN
Suffix:JR
Gender:M
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:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04046-0648
Mailing Address - Country:US
Mailing Address - Phone:207-967-3726
Mailing Address - Fax:207-967-3702
Practice Address - Street 1:21 WESTERN AVE # A
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7354
Practice Address - Country:US
Practice Address - Phone:207-967-3726
Practice Address - Fax:207-967-3702
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME060928OtherANTHEM BX/BS
ME206880000Medicaid
352215816OtherCHAMPUS
ME206880000Medicaid
352215816OtherCHAMPUS