Provider Demographics
NPI:1730137225
Name:FREEMAN, TANDY RICE III (MD)
Entity Type:Individual
Prefix:DR
First Name:TANDY
Middle Name:RICE
Last Name:FREEMAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TANDY
Other - Middle Name:RICE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,PA
Mailing Address - Street 1:25 HIGHLAND PARK VLG
Mailing Address - Street 2:SUITE 100 BOX 391
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-2789
Mailing Address - Country:US
Mailing Address - Phone:469-718-0900
Mailing Address - Fax:469-802-8560
Practice Address - Street 1:1015 N CARROLL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6613
Practice Address - Country:US
Practice Address - Phone:469-718-0900
Practice Address - Fax:469-802-8560
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8114174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15759Medicare UPIN
00K77BMedicare ID - Type Unspecified