Provider Demographics
NPI:1356452791
Name:FREEMAN, ERWYN E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ERWYN
Middle Name:E
Last Name:FREEMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1867 CRANE RIDGE DR STE 101B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4956
Mailing Address - Country:US
Mailing Address - Phone:601-362-8776
Mailing Address - Fax:601-354-8786
Practice Address - Street 1:1867 CRANE RIDGE DR STE 101B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4956
Practice Address - Country:US
Practice Address - Phone:601-362-8776
Practice Address - Fax:601-354-8786
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS06406208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0014968Medicaid