Provider Demographics
NPI:1720097801
Name:FREYER, CRAIG ALAN (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALAN
Last Name:FREYER
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 1:3629 WESTERN CENTER BLVD
Mailing Address - Street 2:201
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1939
Mailing Address - Country:US
Mailing Address - Phone:817-232-9870
Mailing Address - Fax:817-847-7844
Practice Address - Street 1:3629 WESTERN CENTER BLVD
Practice Address - Street 2:201
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1939
Practice Address - Country:US
Practice Address - Phone:817-232-9870
Practice Address - Fax:817-847-7844
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QP93OtherBCBS
TX00QP93Medicare PIN