Provider Demographics
NPI:1033552815
Name:FREITAS, ERIC PAUL (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:PAUL
Last Name:FREITAS
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 1:3900 GRAPEVINE MILLS PKWY UNIT 3633
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-0954
Mailing Address - Country:US
Mailing Address - Phone:347-671-3411
Mailing Address - Fax:
Practice Address - Street 1:900 E SOUTHLAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6376
Practice Address - Country:US
Practice Address - Phone:817-310-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260435207Q00000X
390200000X
TXT6113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program