Provider Demographics
NPI:1609868322
Name:FREEMAN, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
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 1:8106 HIGHLAND GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3312
Mailing Address - Country:US
Mailing Address - Phone:281-343-9050
Mailing Address - Fax:
Practice Address - Street 1:3803 FM 1092 RD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2209
Practice Address - Country:US
Practice Address - Phone:281-403-8271
Practice Address - Fax:281-403-8274
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8540207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139203724OtherCSHCN
TX171918904OtherCSHCN
TX171918901Medicaid
TX82481FOtherBCBS
TX139203701Medicaid
TX82481FOtherBCBS
TX8D4342Medicare ID - Type Unspecified
TX139203701Medicaid
TX82481FMedicare PIN