Basic Information
| Provider Information | |||||||||
| NPI: | 1508861261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARNOLD | ||||||||
| FirstName: | FREDRICK | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 E LAMAR BLVD | ||||||||
| Address2: | STE 450 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760067346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178613994 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2000 E LAMAR BLVD | ||||||||
| Address2: | STE 450 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760067346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178613994 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 006900 | TN | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 3029936 | 01 | TN | BCBS PROVIDER NUMBER | OTHER | 64743180 | 05 | KY | MEDICAID | 009607740 | 05 | AL | MEDICAID | 3177194 | 05 | TN | MEDICAID |