Provider Demographics
NPI:1962583153
Name:SONYA L FREEMAN
Entity type:Organization
Organization Name:SONYA L FREEMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-252-9393
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73534-1048
Mailing Address - Country:US
Mailing Address - Phone:580-252-9393
Mailing Address - Fax:580-252-9395
Practice Address - Street 1:507 CEDAR CREEK
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533
Practice Address - Country:US
Practice Address - Phone:580-252-9393
Practice Address - Fax:580-252-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========003OtherBCBS BILLING NUMBER
OK=========001OtherTRICARE SOUTH REGION
OK=========001OtherTRICARE SOUTH REGION