Provider Demographics
NPI:1801850755
Name:FREESTONE, ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:FREESTONE
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 1:557 W 2600 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7717
Mailing Address - Country:US
Mailing Address - Phone:801-298-9155
Mailing Address - Fax:801-298-9156
Practice Address - Street 1:557 W 2600 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7717
Practice Address - Country:US
Practice Address - Phone:801-298-9155
Practice Address - Fax:801-298-9156
Is Sole Proprietor?:No
Enumeration Date:2006-04-15
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT323550-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000092629Medicare PIN
UTIDX38601OtherUNIV OF UTAH ID
UT141920853OtherUNITED HEALTH CARE
UTPRA02281OtherMOLINA MEDICAID
UT107039775101OtherINTERMOUNTAIN HEALTH CARE
UT005802702OtherMEDICARE
UT243282OtherALTIUS
UT86078OtherPEHP
UT32355012000001OtherBLUECROSS BLUESHIELD
UTI00620Medicare UPIN