Provider Demographics
NPI:1609956564
Name:FREEMAN, LARRY S (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:S
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N COMMERCIAL ST
Mailing Address - Street 2:SUITE 1360
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4446
Mailing Address - Country:US
Mailing Address - Phone:360-752-5527
Mailing Address - Fax:360-752-5543
Practice Address - Street 1:119 N COMMERCIAL ST
Practice Address - Street 2:SUITE 1360
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4446
Practice Address - Country:US
Practice Address - Phone:360-752-5527
Practice Address - Fax:360-752-5543
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000167882084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1430602Medicaid
WAA07189Medicare UPIN