Provider Demographics
NPI:1871629568
Name:FREEMAN, LARRY ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALLAN
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 1:4161 EL CAMINO WAY STE A
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-4084
Mailing Address - Country:US
Mailing Address - Phone:650-493-2022
Mailing Address - Fax:650-493-6022
Practice Address - Street 1:4161 EL CAMINO WAY STE A
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-4084
Practice Address - Country:US
Practice Address - Phone:650-493-2022
Practice Address - Fax:650-493-6022
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25347204C00000X, 207Q00000X, 207QS0010X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25347OtherCA MEDICAL LICENSE #
CAA25347OtherCA MEDICAL LICENSE #
CA00A253470Medicare PIN
CAA24394Medicare UPIN