Provider Demographics
NPI:1538102918
Name:FREEMAN, JENATTA (MD)
Entity Type:Individual
Prefix:
First Name:JENATTA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 ARION PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2880
Mailing Address - Country:US
Mailing Address - Phone:210-349-9300
Mailing Address - Fax:210-366-2558
Practice Address - Street 1:8715 VILLAGE DR
Practice Address - Street 2:SUITE 418
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5405
Practice Address - Country:US
Practice Address - Phone:210-656-3040
Practice Address - Fax:210-656-6419
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2620207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L18093Medicare UPIN