Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 10513 | NV |
N | 207PE0004X | Emergency Medical Services | 10513 | NV |
NPI | 1154380962 |
---|---|
Provider Name | Bret W Frey |
First Address | Reno, NV 89502-1304 |
Second Address | Reno, NV 89502-1576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 21/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100500358 | (05) | NV |
CC9255 | BC/BS (01) | NV |
H93769 | (02) | NV |