Basic Information
| Provider Information | |||||||||
| NPI: | 1942314406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRAIM | ||||||||
| FirstName: | CLIFFORD | ||||||||
| MiddleName: | JACK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 N IH 35 STE 300 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123248300 | ||||||||
| FaxNumber: | 5123248301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 W 38TH ST STE 308 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787316406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123243580 | ||||||||
| FaxNumber: | 5123243581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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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 | 2084N0400X | E4337 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 131702609 | 05 | TX | MEDICAID | 8CX265 | 01 | TX | BCBS | OTHER | 131702610 | 05 | TX | MEDICAID | 1317026-08 | 05 | TX | MEDICAID |