Provider Demographics
NPI:1700031473
Name:FREESH, MARY C (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:FREESH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:F
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:272 E CENTER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6456
Mailing Address - Country:US
Mailing Address - Phone:435-986-2300
Mailing Address - Fax:
Practice Address - Street 1:272 E CENTER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6456
Practice Address - Country:US
Practice Address - Phone:435-986-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-22
Last Update Date:2008-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1730821204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine