Provider Demographics
NPI:1053398271
Name:FREY, WILLIAM BROOKS (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BROOKS
Last Name:FREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-0340
Mailing Address - Country:US
Mailing Address - Phone:903-893-1131
Mailing Address - Fax:903-327-8023
Practice Address - Street 1:5016 S US HIGHWAY 75
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4584
Practice Address - Country:US
Practice Address - Phone:903-892-1131
Practice Address - Fax:903-327-8023
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043696601Medicaid
TX043696601Medicaid
TXA37097Medicare UPIN