1932195328 NPI number — PATRICK R FREY MD

Table of content: PATRICK R FREY MD (NPI 1932195328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932195328 NPI number — PATRICK R FREY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREY
Provider First Name:
PATRICK
Provider Middle Name:
R
Provider Name Prefix Text:
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:
1932195328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 GASTON AVE STE 1205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75246-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-692-8262
Provider Business Mailing Address Fax Number:
214-853-9415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 LANCASTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAPEVINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-915-8502
Provider Business Practice Location Address Fax Number:
682-223-5006
Provider Enumeration Date:
09/21/2005

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: 208800000X , with the licence number:  K9062 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100723902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100723904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100723901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100723903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100723905 . This is a "MEDICAID OTHER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100723906 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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