Provider Demographics
NPI:1801846423
Name:FREEDMAN, DOUGLAS M (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:FREEDMAN
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 1:2021 SANTA MONICA BLVD
Mailing Address - Street 2:#545E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2208
Mailing Address - Country:US
Mailing Address - Phone:310-828-2042
Mailing Address - Fax:310-828-9581
Practice Address - Street 1:2021 SANTA MONICA BLVD
Practice Address - Street 2:#545E
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2208
Practice Address - Country:US
Practice Address - Phone:310-828-2042
Practice Address - Fax:310-828-9581
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG076414207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G764140OtherBS OF CA
CA00G764140Medicaid
G18665Medicare UPIN
CAG76414AMedicare ID - Type Unspecified
CA5120160001Medicare NSC