Basic Information
| Provider Information | |||||||||
| NPI: | 1154305787 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIED | ||||||||
| FirstName: | TERRANCE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7142 SAN PEDRO AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782166256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106615622 | ||||||||
| FaxNumber: | 2103954012 | ||||||||
| Practice Location | |||||||||
| Address1: | 1008 BROOKLYN AVE | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782151617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102280743 | ||||||||
| FaxNumber: | 2102289749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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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 | 207RN0300X | F3128 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 125760201 | 05 | TX | MEDICAID | 390003679 | 01 | MEDICARE RAILROAD | OTHER |