Provider Demographics
NPI:1891876447
Name:FREIMER, GREGORY L (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:FREIMER
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 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9694207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168670107Medicaid
TX75-0818167-048OtherTRICARE
TX75-2616977-028OtherTRICARE
TX8X8168OtherBCBS
TXP01304435OtherRAIL ROAD
TX168670108Medicaid
TX75-2616977-002OtherTRICARE
TXP00688862OtherRAIL ROAD
TXTIN PLUS 015OtherTRICARE
TX168670105Medicaid
TX0014PJOtherBLUE CROSS BLUE SHIELD
TX168670109Medicaid
TX750818167044OtherTRICARE
TXTIN PLUS 005OtherTRICARE
TX168670103Medicaid
TX75-2616977-001OtherTRICARE
TX750818167022OtherTRICARE
TX8U5862OtherBLUE CROSS & BLUE SHIELD
TX168670106Medicaid
TX8DU465OtherBCBS
TXP00647972OtherRAIL ROAD
TX612805Medicare PIN
TX750818167022OtherTRICARE
TX168670109Medicaid
TX168670106Medicaid
TXTXB150510Medicare Oscar/Certification
TX8U5862OtherBLUE CROSS & BLUE SHIELD
TXP01304435OtherRAIL ROAD
TXI16738Medicare UPIN