Provider Demographics
NPI:1821100413
Name:FREY, EDGAR SHEILDS (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:SHEILDS
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 1:860 MONTCLAIR RD STE 754
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1950
Mailing Address - Country:US
Mailing Address - Phone:205-591-2565
Mailing Address - Fax:205-986-0081
Practice Address - Street 1:860 MONTCLAIR RD STE 754
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1950
Practice Address - Country:US
Practice Address - Phone:205-591-2565
Practice Address - Fax:205-986-0081
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11671208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC70712Medicare UPIN
AL000085727Medicare ID - Type Unspecified