Basic Information
| Provider Information | |||||||||
| NPI: | 1053398271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | BROOKS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 340 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750910340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038931131 | ||||||||
| FaxNumber: | 9033278023 | ||||||||
| Practice Location | |||||||||
| Address1: | 5016 S US HIGHWAY 75 | ||||||||
| Address2: | RADIOLOGY DEPARTMENT | ||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750204584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038921131 | ||||||||
| FaxNumber: | 9033278023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 04/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | J5763 | TX | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 043696601 | 05 | TX | MEDICAID |