Individual
TIMOTHY C. FREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5601 N. ANTIOCH, CREEKWOOD FAMILY CARE, STE. 12, GLADSTONE, MO 64119
(816) 452-8000
(816) 455-2383
Mailing address
2330 SHAWNEE MISSION PKWY, MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312, WESTWOOD, KS 66205-2005
(913) 588-9000
(913) 588-9822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
05-19466
KS
207Q00000X
Family Medicine Physician
Primary
R7C61
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080171268
RR MEDICARE
KS
01
—
10001637500
CHP CFC
—
01
—
10001637501
CHP PIC HILLS
—
05
—
100391550A
—
KS
01
—
11207011
BCBS CFC
—
01
—
1186358
AETNA PICS HILLS UC
—
01
—
157695XX
PREFERRED CARE OF NY
—
01
—
18960020
CFU BCBS
—
01
—
2057247
AETNA CFC
—
01
—
22039026
BCBS PIC HILLS UC
—
01
—
25562039
BCBS KUMW UC
—
01
—
326933
FIRSTGUARD KUMW UC
—
01
—
3732650
AETNA KUMW UC
—
01
—
39415017
WW URGENT CARE
—
01
—
481159444
JAYHAWK TAX ID
—
Enumeration date
06/03/2006
Last updated
11/03/2009
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