Provider Demographics
NPI:1821163650
Name:FREEMAN-LADD, MAYRA LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:LOUISE
Last Name:FREEMAN-LADD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 W 30TH AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-2814
Mailing Address - Country:US
Mailing Address - Phone:806-663-5654
Mailing Address - Fax:806-663-5642
Practice Address - Street 1:100 W 30TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2814
Practice Address - Country:US
Practice Address - Phone:806-663-5654
Practice Address - Fax:806-663-5642
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME781032080N0001X
TXN50572080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine