Provider Demographics
NPI:1295704831
Name:FREEMAN, JACK B (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:B
Last Name:FREEMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:SUITE 202, WMP
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6899
Mailing Address - Country:US
Mailing Address - Phone:205-397-8850
Mailing Address - Fax:205-397-8855
Practice Address - Street 1:2006 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 202, WMP
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6899
Practice Address - Country:US
Practice Address - Phone:205-877-2850
Practice Address - Fax:205-877-2858
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12661207VX0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51503786FREMedicare ID - Type UnspecifiedMEDICARE
ALC74751Medicare UPIN