Provider Demographics
NPI:1891091682
Name:FREY, ERIC DETLEF (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DETLEF
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 1:1081 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3130
Mailing Address - Country:US
Mailing Address - Phone:760-446-0121
Mailing Address - Fax:760-446-0734
Practice Address - Street 1:1041 N CHINA LAKE BLVD STE B
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3183
Practice Address - Country:US
Practice Address - Phone:760-446-0121
Practice Address - Fax:760-446-0734
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116953207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine