Provider Demographics
NPI:1447250659
Name:CONTRERAS, FREDDIE L (MD)
Entity type:Individual
Prefix:MR
First Name:FREDDIE
Middle Name:L
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 9600
Mailing Address - Street 2:DEPT 09-019
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-9600
Mailing Address - Country:US
Mailing Address - Phone:903-794-4196
Mailing Address - Fax:903-792-7408
Practice Address - Street 1:1002 TEXAS BLVD
Practice Address - Street 2:STE 406
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5113
Practice Address - Country:US
Practice Address - Phone:903-794-4196
Practice Address - Fax:903-792-7408
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG3244207T00000X
ARR3788207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
104317602OtherINDIGENT HEALTH CARE
TX179117500OtherUS DEPT OF LABOR
TX90017OtherCOLLUM & CARNEY CLINIC
TX1871793307OtherCIGNA DME#
TX84E967OtherBLUE CROSS
AR90017OtherBLUE CROSS
AR113561001OtherMEDICAID
AR113561001Medicaid
TX104317602Medicaid
751716332OtherUNITED HEALTH CARE
TXMDG3244OtherWORKERS' COMPENSATION
TX140001430OtherRAILROAD MEDICARE
TX5575000001OtherCIGNA GOVERNMENT SERVICES
90017OtherFIRST PYRAMID LIFE
OK100118890AMedicaid
AR18382000000OtherQUALCHOICE OF ARK
B21963Medicare UPIN
OK100118890AMedicaid