Provider Demographics
NPI:1750482477
Name:FREEMAN, MATTHEW GAINES (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GAINES
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TOWNCENTER BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1832
Mailing Address - Country:US
Mailing Address - Phone:205-409-0525
Mailing Address - Fax:260-969-6023
Practice Address - Street 1:100 TOWNCENTER BLVD STE 113
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1832
Practice Address - Country:US
Practice Address - Phone:205-409-0525
Practice Address - Fax:260-969-6023
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.27301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I080364OtherPROVIDER NUMBER