Provider Demographics
NPI:1235184458
Name:FREEMAN, JOSEPH R (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:FREEMAN
Suffix:
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-395-8805
Mailing Address - Fax:740-395-8855
Practice Address - Street 1:280 PATTONSVILLE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9452
Practice Address - Country:US
Practice Address - Phone:740-395-8805
Practice Address - Fax:740-395-8855
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5520207Q00000X
WV15255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0990843OtherMOLINA MEDICAID
001714068OtherMOUNTAIN STATE BCBS
080060595OtherRR MEDICARE
000000007537OtherANTHEM BCBS
WV0045424000Medicaid
OH310917085099OtherCARESOURCE MEDICAID
OH000000181664OtherUNISON MEDICAID
OH0990843Medicaid
080060595OtherRR MEDICARE
OHF90492Medicare UPIN
WV0045424000Medicaid