Basic Information
| Provider Information | |||||||||
| NPI: | 1588634364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREITAS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9400 UNIVERSITY PKWY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325145752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509447256 | ||||||||
| FaxNumber: | 8509443990 | ||||||||
| Practice Location | |||||||||
| Address1: | 9400 UNIVERSITY PKWY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325145752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509447256 | ||||||||
| FaxNumber: | 8509443990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 03/30/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME 78108 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080180452 | 01 | FL | RAILROAD MEDICARE | OTHER | 49223 | 01 | FL | BLUE CROSS BLUE SHIELD FL | OTHER | 257324500 | 05 | FL | MEDICAID | 590499893 | 01 | AL | BLUE CROSS BLUE SHIELD AL | OTHER | A534 | 01 | FL | HEALTH FIRST NETWORK | OTHER |