Provider Demographics
NPI:1770524456
Name:EKERY, FRED N (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:N
Last Name:EKERY
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1901 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5113
Practice Address - Country:US
Practice Address - Phone:915-544-6750
Practice Address - Fax:915-532-4259
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0864207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123456905Medicaid
TX8R1432OtherBLUE CROSS OF TEXAS
NM000V6689Medicaid
TX123456901Medicaid
TX123456902Medicaid
TXB22489Medicare UPIN
TX87809KMedicare PIN
TX123456905Medicaid
TX110096352Medicare PIN
TX8R1432OtherBLUE CROSS OF TEXAS