Provider Demographics
NPI:1588760110
Name:FREEMAN, DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
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 1:2458 HILBORN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1072
Mailing Address - Country:US
Mailing Address - Phone:707-646-5500
Mailing Address - Fax:707-646-5501
Practice Address - Street 1:2458 HILBORN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1072
Practice Address - Country:US
Practice Address - Phone:707-646-5500
Practice Address - Fax:707-646-5501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC 51473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC51473OtherMEDICAL LICENSE
CAH72503Medicare UPIN