Provider Information for 1528577491
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JOSEPH LEWIS FREY
Sex: Male
NPI: 1528577491
Last Updated: 2020-02-05
Certification Date: 2020-02-05
Certification Date: 2020-02-05
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1528577491 | ||||||||
| Enumeration Date | 2017-09-23 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 14085 BLACK FOREST RD COLORADO SPRINGS, CO 80908-2854 United States Phone: 763-772-8111 | Fax: | ||||||||
| Primary Practice Address | 14085 BLACK FOREST RD COLORADO SPRINGS, CO 80908 United States Phone: 719-323-6674 | Fax: | ||||||||
| Secondary Practice Address(es) | 11070 183RD CIR NW STE C 11070 183RD CIR NW STE C | ||||||||
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