Provider Demographics
NPI:1538142617
Name:PASSMANN, FREDERIC K (MD)
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:K
Last Name:PASSMANN
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 1:821 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASPERMONT
Mailing Address - State:TX
Mailing Address - Zip Code:79502
Mailing Address - Country:US
Mailing Address - Phone:940-989-3551
Mailing Address - Fax:940-989-3662
Practice Address - Street 1:821 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ASPERMONT
Practice Address - State:TX
Practice Address - Zip Code:79502
Practice Address - Country:US
Practice Address - Phone:940-989-3551
Practice Address - Fax:940-989-3662
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6646207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140167121Medicaid
TX140167121Medicaid
TX140167121Medicaid