Provider Demographics
NPI:1649229436
Name:FREEMAN, MARC
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3175
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3175
Mailing Address - Country:US
Mailing Address - Phone:855-613-5392
Mailing Address - Fax:855-853-5104
Practice Address - Street 1:1800 BARRS ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4704
Practice Address - Country:US
Practice Address - Phone:904-388-1562
Practice Address - Fax:904-388-1841
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00202942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035852500Medicaid
FL68032OtherBC BS
FL300017433OtherRR MEDICARE
GA000198547AMedicaid
FL68032OtherBC BS
GA000198547AMedicaid
GA000198547AMedicaid