Provider Demographics
NPI:1265779987
Name:FREY, MATTHEW B (AP, DOM)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:B
Last Name:FREY
Suffix:
Gender:M
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4208
Mailing Address - Country:US
Mailing Address - Phone:419-215-2562
Mailing Address - Fax:
Practice Address - Street 1:1853 5TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4208
Practice Address - Country:US
Practice Address - Phone:419-215-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3212171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist