Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 2901017047 | MI |
Y | 213EG0000X | General Practice | 2901017047 | MI |
NPI | 1003815002 |
---|---|
Provider Name | Dr. John Thomas Frey |
First Address | Belmont, MI 49306-8709 |
Second Address | Belmont, MI 49306-8708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 06/02/2012 |