Provider Demographics
NPI:1861492787
Name:FREEMAN, ROBERT JAY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAY
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 1:2455 NE LOOP 410
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5649
Mailing Address - Country:US
Mailing Address - Phone:210-599-6000
Mailing Address - Fax:210-657-5586
Practice Address - Street 1:2455 NE LOOP 410
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5649
Practice Address - Country:US
Practice Address - Phone:210-599-6000
Practice Address - Fax:210-657-5586
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G5640OtherWELLMED MEDICARE
TX1362949-10OtherWELLMED MEDICAID
E43861Medicare UPIN