Provider Demographics
NPI:1619977956
Name:FREEMAN, THEODORE MONROE (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:MONROE
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 1:2833 BABCOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5390
Mailing Address - Country:US
Mailing Address - Phone:210-614-7594
Mailing Address - Fax:210-614-3391
Practice Address - Street 1:2833 BABCOCK RD
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5390
Practice Address - Country:US
Practice Address - Phone:210-614-7594
Practice Address - Fax:210-614-3391
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7145207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142764301Medicaid
TX142764301Medicaid