Provider Demographics
NPI:1861783029
Name:FREEDMAN, LAWRENCE DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DAVID
Last Name:FREEDMAN
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 1:2110 YACHT MISCHIEF
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6714
Mailing Address - Country:US
Mailing Address - Phone:949-720-0479
Mailing Address - Fax:949-720-0479
Practice Address - Street 1:2110 YACHT MISCHIEF
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6714
Practice Address - Country:US
Practice Address - Phone:949-720-0479
Practice Address - Fax:949-720-0479
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE6213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine