Healthcare Provider Details

I. General information

NPI: 1306751441
Provider Name (Legal Business Name): ROBERT BRIAN FREY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W MAIN ST
BENTON IL
62812-1565
US

IV. Provider business mailing address

1102 W WHITE ST
MARION IL
62959-1060
US

V. Phone/Fax

Practice location:
  • Phone: 618-439-3399
  • Fax:
Mailing address:
  • Phone: 618-922-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number160009176
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: