Provider Demographics
NPI:1154359859
Name:FREEMAN, RICHARD C (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
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 1:10221 N FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9565
Mailing Address - Country:US
Mailing Address - Phone:509-991-5750
Mailing Address - Fax:
Practice Address - Street 1:10221 N FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9565
Practice Address - Country:US
Practice Address - Phone:509-991-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015819207Q00000X
IDM-3778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8856242Medicare ID - Type Unspecified
E07056Medicare UPIN