Healthcare Provider Details

I. General information

NPI: 1922471010
Provider Name (Legal Business Name): BRETT FREDIEU R.R.T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 FANNIN ST
HOUSTON TX
77030-5400
US

IV. Provider business mailing address

7500 KIRBY DR APT. 1220
HOUSTON TX
77030-4300
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-3130
  • Fax:
Mailing address:
  • Phone: 318-402-8573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: