Provider Demographics
NPI:1912990722
Name:FREEBORN, WILLIAM ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ARTHUR
Last Name:FREEBORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:506 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-3928
Mailing Address - Country:US
Mailing Address - Phone:830-997-1136
Mailing Address - Fax:830-997-1136
Practice Address - Street 1:506 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-3928
Practice Address - Country:US
Practice Address - Phone:830-997-1136
Practice Address - Fax:830-997-1136
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD9442208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15741Medicare UPIN
TX00462GMedicare PIN