Basic Information
| Provider Information | |||||||||
| NPI: | 1174813026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREYDER | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | S | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2129 | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797602129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326402408 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8050 E HIGHWAY 191 STE 210 | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797658615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326406446 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 12/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 307239 | LA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208600000X | 126060526 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 207X00000X | S8986 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.