Provider Demographics
NPI:1417957259
Name:FREEMAN, GEORGE EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1425 E LINCOLN RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7345
Mailing Address - Country:US
Mailing Address - Phone:580-286-4949
Mailing Address - Fax:580-286-4946
Practice Address - Street 1:1425 E LINCOLN RD
Practice Address - Street 2:SUITE B1
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7345
Practice Address - Country:US
Practice Address - Phone:580-286-4949
Practice Address - Fax:580-286-4946
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3192207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100253460AMedicaid
OK442682460-002OtherBLUE CROSS BLUE SHIELD
OK731588859OtherTAX ID NUMBER
OKG50066Medicare UPIN