1447250659 NPI number — MR. FREDDIE L CONTRERAS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447250659 NPI number — MR. FREDDIE L CONTRERAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONTRERAS
Provider First Name:
FREDDIE
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447250659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 9600
Provider Second Line Business Mailing Address:
DEPT 09-019
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75505-9600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-794-4196
Provider Business Mailing Address Fax Number:
903-792-7408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 TEXAS BLVD
Provider Second Line Business Practice Location Address:
STE 406
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75501-5113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-794-4196
Provider Business Practice Location Address Fax Number:
903-792-7408
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  G3244 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207T00000X , with the licence number: R3788 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104317602 . This is a "INDIGENT HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 179117500 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 90017 . This is a "COLLUM & CARNEY CLINIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1871793307 . This is a "CIGNA DME#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 84E967 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 90017 . This is a "BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 113561001 . This is a "MEDICAID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 113561001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104317602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 751716332 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: MDG3244 . This is a "WORKERS' COMPENSATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 140001430 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5575000001 . This is a "CIGNA GOVERNMENT SERVICES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 90017 . This is a "FIRST PYRAMID LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100118890A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18382000000 . This is a "QUALCHOICE OF ARK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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