Provider Demographics
NPI:1336156488
Name:FREESEMANN, JEFFERY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:
Last Name:FREESEMANN
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 1:1925 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4201
Mailing Address - Country:US
Mailing Address - Phone:661-323-2295
Mailing Address - Fax:661-323-8040
Practice Address - Street 1:1925 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4201
Practice Address - Country:US
Practice Address - Phone:661-323-2295
Practice Address - Fax:661-323-8040
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG831220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01707ZOtherMEDICARE GROUP ID#
CA1619968583OtherGROUP NPI
CAGR0092950Medicaid
CAG831220OtherSTATE LICENSE #
CAZZZ01707ZOtherMEDICARE GROUP ID#
00G831221Medicare PIN