Provider Demographics
NPI:1932200292
Name:FREED, JONATHAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ROBERT
Last Name:FREED
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 1:3180 BELL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9200
Mailing Address - Country:US
Mailing Address - Phone:530-885-4151
Mailing Address - Fax:530-885-4131
Practice Address - Street 1:3180 BELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-9200
Practice Address - Country:US
Practice Address - Phone:530-885-4151
Practice Address - Fax:530-885-4131
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG072375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF99685Medicare UPIN
CA00G723750Medicare ID - Type Unspecified