MEDICARE: DENNIS J FRIESEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	10504	OK

General Provider Information

NPI Number	:	1477668564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS J FRIESEN M.D.

Provider Business Mailing Address
First Line	:	206 GROVE AVE
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-2402
Country	:	US
Telephone Number	:	580-225-8600
Fax Number	:	580-225-8601

Provider Business Practice Location Address
First Line	:	1710 W 3RD ST
Second Line	:	SUITE 103B
City	:	ELK CITY
State	:	OK
Zip	:	73644-5159
Country	:	US
Telephone Number	:	580-225-8600
Fax Number	:	580-225-8601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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