Provider Demographics
NPI:1295921948
Name:FREEMAN, WIYATTA BENDU (MD)
Entity type:Individual
Prefix:
First Name:WIYATTA
Middle Name:BENDU
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11914 ASTORIA BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6050
Mailing Address - Country:US
Mailing Address - Phone:713-486-7680
Mailing Address - Fax:713-486-9301
Practice Address - Street 1:11914 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6064
Practice Address - Country:US
Practice Address - Phone:713-486-7680
Practice Address - Fax:713-486-9301
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8656207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CB829OtherBLUE CROSS/BLUE SHIELD
TX8F22199OtherDALLAS COUNTY PTAN
TX8L27311OtherTARRANT COUNTY PTAN