David Immanuel Freeman Fountain, PA

NPI #1457978611 in Durango, Colorado

Provider Information

NPI Number: 1457978611
Entity Type: Individual
Name: David Immanuel Freeman Fountain, PA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Jul 2, 2020
Last Updated: Nov 8, 2024

Practice Location

Address: 114 COTTONWOOD CREEK RD APT A1
City: Durango
State: Colorado
ZIP Code: 81301-6163
Phone: (970) 749-9113

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X
Physician Assistant	363A00000X	Primary

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