Provider Demographics
NPI:1821005372
Name:FREEMAN, DUDLEY E (MD)
Entity Type:Individual
Prefix:
First Name:DUDLEY
Middle Name:E
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 1:7620 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2154
Mailing Address - Country:US
Mailing Address - Phone:806-359-5468
Mailing Address - Fax:806-358-1162
Practice Address - Street 1:7620 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2154
Practice Address - Country:US
Practice Address - Phone:806-359-5468
Practice Address - Fax:806-358-1162
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5529207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140997106Medicaid
TX8A6471Medicare ID - Type Unspecified
TX140997106Medicaid