Basic Information
| Provider Information | |||||||||
| NPI: | 1932195328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREY | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 GASTON AVE STE 1205 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752461812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146928262 | ||||||||
| FaxNumber: | 2148539415 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 LANCASTER DR | ||||||||
| Address2: | |||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149158502 | ||||||||
| FaxNumber: | 6822235006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 09/11/2018 | ||||||||
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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 | 208800000X | K9062 | TX | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 100723902 | 05 | TX | MEDICAID | 100723904 | 05 | TX | MEDICAID | 100723901 | 05 | TX | MEDICAID | 100723903 | 05 | TX | MEDICAID | 100723905 | 01 | TX | MEDICAID OTHER | OTHER | 100723906 | 05 | TX | MEDICAID |