Basic Information
| Provider Information | |||||||||
| NPI: | 1043208879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRISBIE | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | VAN BUREN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729565830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794745061 | ||||||||
| FaxNumber: | 4799222007 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | VAN BUREN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729565830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794745061 | ||||||||
| FaxNumber: | 4799222007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 08/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | E2242 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 137766001 | 05 | AR | MEDICAID | 200014700A | 05 | OK | MEDICAID | E2242 | 01 | AR | ARKANSAS STATE LICENSE | OTHER | 5L241 | 01 | AR | BLUE CROSS | OTHER | BF4135768 | 01 | AR | DEA | OTHER | 04D1061540 | 01 | AR | CLIA | OTHER |