Provider Demographics
NPI:1952366080
Name:FREEMAN, TIJUANA LISETTE (MD)
Entity Type:Individual
Prefix:
First Name:TIJUANA
Middle Name:LISETTE
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 1:3650 GROVELAND RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5753
Mailing Address - Country:US
Mailing Address - Phone:228-875-0780
Mailing Address - Fax:228-875-1009
Practice Address - Street 1:3650 GROVELAND RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5753
Practice Address - Country:US
Practice Address - Phone:228-875-0780
Practice Address - Fax:228-875-1009
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15040208000000X
ARE-1828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135418001Medicaid
AR1832000000OtherQUAL CHOICE
AR1222017OtherUNITED HEALTH CARE
AR135418001Medicaid
ARG75396Medicare UPIN