Provider Demographics
NPI:1275520165
Name:FREEMAN, MATTHEW LYNN (PA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LYNN
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 E SHARON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6599
Mailing Address - Country:US
Mailing Address - Phone:479-251-1905
Mailing Address - Fax:
Practice Address - Street 1:RR 6 BOX 840
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-8703
Practice Address - Country:US
Practice Address - Phone:918-696-8800
Practice Address - Fax:918-696-3879
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA1384363AM0700X
TXPA02983363AM0700X
ARPA216363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1601384Medicaid
OK1601384Medicaid