Provider Demographics
NPI:1598887796
Name:REES G. FREEMAN, M.D., P.C.
Entity Type:Organization
Organization Name:REES G. FREEMAN, M.D., P.C.
Other - Org Name:NORTHWEST NEUROSURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:AUTUMN
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:541-464-4640
Mailing Address - Street 1:1813 W HARVARD AVE
Mailing Address - Street 2:SUITE #330
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-2752
Mailing Address - Country:US
Mailing Address - Phone:541-464-4640
Mailing Address - Fax:541-464-4641
Practice Address - Street 1:1813 W HARVARD AVE
Practice Address - Street 2:SUITE #330
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2752
Practice Address - Country:US
Practice Address - Phone:541-464-4640
Practice Address - Fax:541-464-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13996207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR220632Medicaid
ORR118428Medicare ID - Type UnspecifiedGROUP ID #
OR220632Medicaid