Provider Demographics
NPI:1518025717
Name:FREY, GERALD CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:CHARLES
Last Name:FREY
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:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-1527
Mailing Address - Country:US
Mailing Address - Phone:509-628-3961
Mailing Address - Fax:
Practice Address - Street 1:355 ROCKWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-8542
Practice Address - Country:US
Practice Address - Phone:509-628-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA15281208000000X
AZ7414208000000X
WI17937020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1007822Medicaid
F65963Medicare UPIN