Healthcare Provider Details

I. General information

NPI: 1346424553
Provider Name (Legal Business Name): JASON AARON FREY R.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 BATESVILLE SHOPPING VILLAGE
BATESVILLE IN
47006
US

IV. Provider business mailing address

675 STATE ROAD 229 SOUTH
BATESVILLE IN
47006
US

V. Phone/Fax

Practice location:
  • Phone: 812-932-1122
  • Fax:
Mailing address:
  • Phone: 812-209-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: