Provider Demographics
NPI:1114976099
Name:FREI, LONNIE WARREN (MD)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:WARREN
Last Name:FREI
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 1:2101 N WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4836
Mailing Address - Country:US
Mailing Address - Phone:909-881-7605
Mailing Address - Fax:760-656-1199
Practice Address - Street 1:2101 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4836
Practice Address - Country:US
Practice Address - Phone:909-881-7605
Practice Address - Fax:760-656-1199
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS203312086S0127X
PAMD4287182086S0127X
CAG859752086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12618OtherHEALTH PARTNERS
PA1374973OtherPERSONAL CHOICE
PA30034495OtherKEYSTONE MERCY
PA101672108-02OtherAMERICHOICE FRANKFORD DIV
PA1016721080003Medicaid
PA101672108-01OtherAMERICHOICE TORRESDALE DI
PA1374973OtherHIGHMARK BLUE SHIELD
AL159193Medicaid
MS05388848Medicaid
PA101672108-03OtherAMERICHOICE BUCKS DIVISIO
PA1016721080002Medicaid
PA1016721080001Medicaid
PA2066559000OtherKEYSTONE, IBC
MSP01435626Medicare PIN
PA2066559000OtherKEYSTONE, IBC
PAC04791Medicare UPIN
MS512I020067Medicare PIN