Basic Information
Provider Information
NPI: 1932177284
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRIMBERGER
FirstName: DOMINIC
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1122 NE 13TH ST
Address2: ORI236
City: OKLAHOMA CITY
State: OK
PostalCode: 731171039
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1200 N PHILLIPS AVE
Address2: SUITE 7100
City: OKLAHOMA CITY
State: OK
PostalCode: 731044600
CountryCode: US
TelephoneNumber: 4052713800
FaxNumber: 4052713399
Other Information
ProviderEnumerationDate: 03/12/2006
LastUpdateDate: 01/20/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000X23777OKY Allopathic & Osteopathic PhysiciansUrology 

No ID Information.


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