Provider Demographics
NPI:1710019740
Name:FREEMAN, MARK H (NP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:H
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LECH WALESA
Mailing Address - Street 2:TOM WADDELL CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4506
Mailing Address - Country:US
Mailing Address - Phone:415-355-7490
Mailing Address - Fax:415-355-7407
Practice Address - Street 1:50 LECH WALESA
Practice Address - Street 2:TOM WADDELL CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4506
Practice Address - Country:US
Practice Address - Phone:415-355-7490
Practice Address - Fax:415-355-7407
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN397538163WC1500X
CANPF3259363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
056283OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
056283OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER