Healthcare Provider Details

I. General information

NPI: 1114976099
Provider Name (Legal Business Name): LONNIE WARREN FREI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WATERMAN AVE
SAN BERNARDINO CA
92404-4836
US

IV. Provider business mailing address

2101 N WATERMAN AVE
SAN BERNARDINO CA
92404-4836
US

V. Phone/Fax

Practice location:
  • Phone: 909-881-7605
  • Fax: 760-656-1199
Mailing address:
  • Phone: 909-881-7605
  • Fax: 760-656-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number20331
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD428718
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberG85975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: