Basic Information
| Provider Information | |||||||||
| NPI: | 1538142617 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PASSMANN | ||||||||
| FirstName: | FREDERIC | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 821 N BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | ASPERMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9409893551 | ||||||||
| FaxNumber: | 9409893662 | ||||||||
| Practice Location | |||||||||
| Address1: | 821 N BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | ASPERMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9409893551 | ||||||||
| FaxNumber: | 9409893662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 09/30/2016 | ||||||||
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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 | 207PE0004X | J6646 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207Q00000X | J6646 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 140167121 | 05 | TX | MEDICAID |