Provider Demographics
NPI:1134114093
Name:FRERKING, TYRUS R (DO)
Entity Type:Individual
Prefix:
First Name:TYRUS
Middle Name:R
Last Name:FRERKING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 PALUXY RD STE 1400
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5655
Mailing Address - Country:US
Mailing Address - Phone:817-579-3970
Mailing Address - Fax:817-579-3969
Practice Address - Street 1:1310 PALUXY RD STE 1400
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5655
Practice Address - Country:US
Practice Address - Phone:817-579-3970
Practice Address - Fax:817-579-3969
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8355207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
OH0748203Medicaid
FR0649784Medicare ID - Type Unspecified
TXPENDINGMedicaid
TXPENDINGMedicare PIN