Provider Demographics
NPI:1558482737
Name:FREEMAN-TRUDO, JONI LEANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:JONI
Middle Name:LEANN
Last Name:FREEMAN-TRUDO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-1013
Mailing Address - Country:US
Mailing Address - Phone:210-233-7000
Mailing Address - Fax:210-434-1704
Practice Address - Street 1:8210 CALLAGHAN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4775
Practice Address - Country:US
Practice Address - Phone:210-233-7000
Practice Address - Fax:210-348-9607
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04379363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y1861OtherBCBS
TX186001701Medicaid
TXP00640987Medicare PIN
TX8J7102Medicare PIN