Provider Demographics
NPI:1578557203
Name:FRETS, ROBERT LYNN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LYNN
Last Name:FRETS
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 1:1255 ASHBY ST
Mailing Address - Street 2:STE I
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5100
Mailing Address - Country:US
Mailing Address - Phone:830-372-1615
Mailing Address - Fax:830-372-1905
Practice Address - Street 1:1255 ASHBY ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5100
Practice Address - Country:US
Practice Address - Phone:830-372-1615
Practice Address - Fax:830-372-1905
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099455002Medicaid
TX099455002Medicaid
TX00ME19Medicare ID - Type Unspecified