Provider Demographics
NPI:1427246974
Name:FREEMAN, MARK E (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
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 1:101 ENERGY PKWY
Mailing Address - Street 2:STE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3872
Mailing Address - Country:US
Mailing Address - Phone:337-484-1178
Mailing Address - Fax:337-534-8311
Practice Address - Street 1:101 ENERGY PKWY
Practice Address - Street 2:STE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3872
Practice Address - Country:US
Practice Address - Phone:337-484-1178
Practice Address - Fax:337-534-8311
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA192168Medicaid
LAE96933Medicare UPIN
LA5N656Medicare PIN