Provider Demographics
NPI:1285079681
Name:FREEMAN, GEORGE MARK JR (MD, PHD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MARK
Last Name:FREEMAN
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 QUARRY RD.
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5717
Mailing Address - Country:US
Mailing Address - Phone:650-723-6643
Mailing Address - Fax:650-723-4655
Practice Address - Street 1:401 QUARRY RD.
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5717
Practice Address - Country:US
Practice Address - Phone:650-723-6643
Practice Address - Fax:650-723-4655
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1317322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry