Basic Information
| Provider Information | |||||||||
| NPI: | 1447250659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONTRERAS | ||||||||
| FirstName: | FREDDIE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 9600 | ||||||||
| Address2: | DEPT 09-019 | ||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755059600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037944196 | ||||||||
| FaxNumber: | 9037927408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 TEXAS BLVD | ||||||||
| Address2: | STE 406 | ||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755015113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037944196 | ||||||||
| FaxNumber: | 9037927408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 11/18/2009 | ||||||||
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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 | 207T00000X | G3244 | TX | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | R3788 | AR | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 104317602 | 01 | INDIGENT HEALTH CARE | OTHER | 179117500 | 01 | TX | US DEPT OF LABOR | OTHER | 90017 | 01 | TX | COLLUM & CARNEY CLINIC | OTHER | 1871793307 | 01 | TX | CIGNA DME# | OTHER | 84E967 | 01 | TX | BLUE CROSS | OTHER | 90017 | 01 | AR | BLUE CROSS | OTHER | 113561001 | 01 | AR | MEDICAID | OTHER | 113561001 | 05 | AR | MEDICAID | 104317602 | 05 | TX | MEDICAID | 751716332 | 01 | UNITED HEALTH CARE | OTHER | MDG3244 | 01 | TX | WORKERS' COMPENSATION | OTHER | 140001430 | 01 | TX | RAILROAD MEDICARE | OTHER | 5575000001 | 01 | TX | CIGNA GOVERNMENT SERVICES | OTHER | 90017 | 01 | FIRST PYRAMID LIFE | OTHER | 100118890A | 05 | OK | MEDICAID | 18382000000 | 01 | AR | QUALCHOICE OF ARK | OTHER |