Provider Demographics
NPI:1275854663
Name:FREEDOM ER PHYSICIANS PLLC
Entity Type:Organization
Organization Name:FREEDOM ER PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KONJOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:409-719-7413
Mailing Address - Street 1:1604 TALLOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-4655
Mailing Address - Country:US
Mailing Address - Phone:409-719-7413
Mailing Address - Fax:409-724-0473
Practice Address - Street 1:5500 39TH ST
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-2905
Practice Address - Country:US
Practice Address - Phone:409-719-7413
Practice Address - Fax:409-724-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-20
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty