Doctor Name: | MR. MATTHEW LYNN FREEMAN |
NPI Number: | 1275520165 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | PA02983 |
Business Practice Address: | Rr 6 Box 840 Stilwell, OK - 749608703 |
Business Phone Number: | 9186968800 |
Business Fax Number: | 9186963879 |
Mailing Address: | 2540 E Sharon St, FAYETTEVILLE |
State: | AR |
Postal Code: | 727036599 |
Phone Number: | 4792511905 |
Fax Number: | |
NPI Enumeration Date: | 10/05/2005 |
NPI Last Update Date: | 01/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA02983 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |