Provider Demographics
NPI:1982915252
Name:ROBERT L FRETS MD PA
Entity Type:Organization
Organization Name:ROBERT L FRETS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRETS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-372-1615
Mailing Address - Street 1:1255 ASHBY ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5118
Mailing Address - Country:US
Mailing Address - Phone:830-372-1615
Mailing Address - Fax:830-372-1905
Practice Address - Street 1:1255 ASHBY ST
Practice Address - Street 2:SUITE I
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5118
Practice Address - Country:US
Practice Address - Phone:830-372-1615
Practice Address - Fax:830-372-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099455002Medicaid
TXB22786Medicare UPIN