Provider Demographics
NPI:1932195328
Name:FREY, PATRICK R (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:FREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3600 GASTON AVE STE 1205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1812
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-853-9415
Practice Address - Street 1:1625 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:214-915-8502
Practice Address - Fax:682-223-5006
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK9062208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100723902Medicaid
TX100723904Medicaid
TX100723901Medicaid
TX100723903Medicaid
TX100723905OtherMEDICAID OTHER
TX100723906Medicaid
TX100723906Medicaid
TX8J8480Medicare PIN
TX100723903Medicaid
TX100723901Medicaid