Healthcare Provider Details

I. General information

NPI: 1265487185
Provider Name (Legal Business Name): FRINE T ROCA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FRINE E DE DIOS MD

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 GRAND AVE NW STE B
FORT PAYNE AL
35967-2107
US

IV. Provider business mailing address

205 GRAND AVE NW STE B
FORT PAYNE AL
35967-2107
US

V. Phone/Fax

Practice location:
  • Phone: 256-979-1515
  • Fax: 256-979-1517
Mailing address:
  • Phone: 256-979-1515
  • Fax: 256-979-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00016324
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: