Provider Demographics
NPI:1013180744
Name:FREY, JEFFREY ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:FREY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:909 FEE RD
Mailing Address - Street 2:FEE HALL ROOM B119
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-3603
Mailing Address - Country:US
Mailing Address - Phone:517-353-3070
Mailing Address - Fax:517-432-3603
Practice Address - Street 1:909 FEE RD
Practice Address - Street 2:FEE HALL ROOM B119
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-3603
Practice Address - Country:US
Practice Address - Phone:517-353-3070
Practice Address - Fax:517-432-3603
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010177822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013180744Medicaid