Provider Demographics
NPI:1982700746
Name:FREEDMAN MD PA, DONALD S (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:S
Last Name:FREEDMAN MD PA
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 1:4063 SALISBURY RD
Mailing Address - Street 2:205
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8030
Mailing Address - Country:US
Mailing Address - Phone:904-281-0460
Mailing Address - Fax:904-714-4270
Practice Address - Street 1:480 BUSCH DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5553
Practice Address - Country:US
Practice Address - Phone:904-281-0460
Practice Address - Fax:904-296-2211
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0031964207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D61769Medicare UPIN
FL15435Medicare ID - Type Unspecified