Provider Demographics
NPI:1760670046
Name:L. WAYNE FREEMAN M.D. INC.
Entity Type:Organization
Organization Name:L. WAYNE FREEMAN M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-799-2020
Mailing Address - Street 1:10861 CHERRY ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5403
Mailing Address - Country:US
Mailing Address - Phone:562-799-2020
Mailing Address - Fax:562-598-7383
Practice Address - Street 1:10861 CHERRY ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5403
Practice Address - Country:US
Practice Address - Phone:562-799-2020
Practice Address - Fax:562-598-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4502750001Medicare NSC
CAW326AMedicare PIN
CAA44905Medicare UPIN