Provider Demographics
NPI:1629230396
Name:FREEMAN, WILLIAM ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALEXANDER
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 1:600 CLUB LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3624
Mailing Address - Country:US
Mailing Address - Phone:501-327-0110
Mailing Address - Fax:501-327-0141
Practice Address - Street 1:600 CLUB LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3624
Practice Address - Country:US
Practice Address - Phone:501-327-0110
Practice Address - Fax:501-327-0141
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE6260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE6260OtherMEDICAL LICENSE
AR1629230396OtherNPI
AR5AJ27G546OtherMEDICARE GROUP MEMBER PTAN
AR5G546OtherMEDICARE GROUP PTAN
AR188405001Medicaid
AR1982721882OtherMEDICARE GROUP NPI
AR1982721882OtherMEDICARE GROUP NPI