Provider Demographics
NPI:1154437200
Name:FREED, ROGER LEE (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:LEE
Last Name:FREED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROGER
Other - Middle Name:LEE
Other - Last Name:FREED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3020 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4010
Mailing Address - Country:US
Mailing Address - Phone:415-567-8908
Mailing Address - Fax:415-383-1816
Practice Address - Street 1:3020 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4010
Practice Address - Country:US
Practice Address - Phone:415-567-8908
Practice Address - Fax:415-383-1816
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-31528174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060805OtherMENTALHEALTHNETWORK