MEDICARE: CRAIG ALAN FREYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G5062	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00QP93	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1720097801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG ALAN FREYER MD

Provider Business Mailing Address
First Line	:	3629 WESTERN CENTER BLVD
Second Line	:	201
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1939
Country	:	US
Telephone Number	:	817-232-9870
Fax Number	:	817-847-7844

Provider Business Practice Location Address
First Line	:	3629 WESTERN CENTER BLVD
Second Line	:	201
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1939
Country	:	US
Telephone Number	:	817-232-9870
Fax Number	:	817-847-7844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2006
Last Update Date	:	02/20/2009

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