Provider Demographics
NPI:1336119148
Name:FREITAG, DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:FREITAG
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 1:1610 5TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2622
Mailing Address - Country:US
Mailing Address - Phone:806-765-2611
Mailing Address - Fax:806-687-5826
Practice Address - Street 1:406 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79403-5210
Practice Address - Country:US
Practice Address - Phone:806-767-9744
Practice Address - Fax:806-767-9930
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135110801Medicaid
TX135110803Medicaid
TX00J91EOtherBC/BS NUMBER
TX135110801Medicaid
TX00J91EMedicare ID - Type Unspecified
TX00J91EOtherBC/BS NUMBER