Basic Information
| Provider Information | |||||||||
| NPI: | 1871600866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | L | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12446 WEST AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782162530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103865400 | ||||||||
| FaxNumber: | 2105251669 | ||||||||
| Practice Location | |||||||||
| Address1: | 12446 WEST AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782162530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103865400 | ||||||||
| FaxNumber: | 2105251669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | G5903 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 8CM504 | 01 | TX | BCBS | OTHER | P00898236 | 01 | TX | RAILROAD MEDICARE | OTHER | 105776204 | 05 | TX | MEDICAID | TXB112461 | 01 | TX | MEDICARE | OTHER |