Provider Demographics
NPI:1689688228
Name:FREEMAN, JOHN W (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 MILO AVE
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-6411
Mailing Address - Country:US
Mailing Address - Phone:409-962-1361
Mailing Address - Fax:
Practice Address - Street 1:4021 MILO AVE
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-6411
Practice Address - Country:US
Practice Address - Phone:409-962-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231550282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access