Basic Information
| Provider Information | |||||||||
| NPI: | 1720085517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRENTZ | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 490 | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396490490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012504366 | ||||||||
| FaxNumber: | 6012504367 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 RAWLS DR STE 500 | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012494282 | ||||||||
| FaxNumber: | 6012494852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 024773 | LA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 22089 | MS | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00253396 | 01 | LA | PALMETTO GBA - RAILROAD M | OTHER | 1579475 | 05 | LA | MEDICAID |