Provider Demographics
NPI:1316026784
Name:FREED, ROBERT LESTER (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LESTER
Last Name:FREED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 SAND CANYON AVE
Mailing Address - Street 2:SUITE 708
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:949-753-1666
Mailing Address - Fax:949-753-9115
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:SUITE 708
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-753-1666
Practice Address - Fax:949-753-9115
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32247207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA322471Medicaid
CAA322471Medicaid
A26742Medicare UPIN