Provider Demographics
NPI:1669415147
Name:FREEMAN, JOHN WALTER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WALTER
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 1:10840 TEXAS HEALTH TRL STE 250
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6850
Mailing Address - Country:US
Mailing Address - Phone:817-750-1310
Mailing Address - Fax:817-750-1311
Practice Address - Street 1:10840 TEXAS HEALTH TRL STE 250
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6850
Practice Address - Country:US
Practice Address - Phone:817-750-1310
Practice Address - Fax:817-750-1311
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3967207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160030021OtherRAILROAD MEDICARE
TX120469506Medicaid
TX120469504Medicaid
TX120469504Medicaid
TX80X139Medicare PIN