Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | G85975 | CA |
N | 2086S0127X | Trauma Surgeon | 20331 | MS |
N | 2086S0127X | Trauma Surgeon | MD428718 | PA |
NPI | 1114976099 |
---|---|
Provider Name | Lonnie Warren Frei |
First Address | San Bernardino, CA 92404-4836 |
Second Address | San Bernardino, CA 92404-4836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05388848 | (05) | MS |
1016721080001 | (05) | PA |
1016721080002 | (05) | PA |
1016721080003 | (05) | PA |
101672108-01 | AMERICHOICE TORRESDALE DI (01) | PA |
101672108-02 | AMERICHOICE FRANKFORD DIV (01) | PA |
101672108-03 | AMERICHOICE BUCKS DIVISIO (01) | PA |
12618 | HEALTH PARTNERS (01) | PA |
1374973 | HIGHMARK BLUE SHIELD (01) | PA |
1374973 | PERSONAL CHOICE (01) | PA |
159193 | (05) | AL |
2066559000 | KEYSTONE, IBC (01) | PA |
30034495 | KEYSTONE MERCY (01) | PA |
C04791 | (02) | PA |