Provider Demographics
NPI:1790213528
Name:COMMONWEALTH ANESTHESIA ASSOCIATES LTD
Entity Type:Organization
Organization Name:COMMONWEALTH ANESTHESIA ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHETIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, DNP
Authorized Official - Phone:214-502-7062
Mailing Address - Street 1:PO BOX 795125
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-5125
Mailing Address - Country:US
Mailing Address - Phone:214-502-7062
Mailing Address - Fax:
Practice Address - Street 1:1600 COIT RD STE 301
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6172
Practice Address - Country:US
Practice Address - Phone:972-867-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255639367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty