Provider Demographics
NPI:1154305787
Name:FRIED, TERRANCE A (MD)
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:A
Last Name:FRIED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7142 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6256
Mailing Address - Country:US
Mailing Address - Phone:210-661-5622
Mailing Address - Fax:210-395-4012
Practice Address - Street 1:1008 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1617
Practice Address - Country:US
Practice Address - Phone:210-228-0743
Practice Address - Fax:210-228-9749
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3128207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125760201Medicaid
390003679OtherMEDICARE RAILROAD
TXC15779Medicare UPIN
TX86G209Medicare PIN