Healthcare Provider Details

I. General information

NPI: 1588126981
Provider Name (Legal Business Name): PHILIP JAY MENDEZ FRAYRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W 42ND AVE
PINE BLUFF AR
71603-7018
US

IV. Provider business mailing address

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 870-560-6534
  • Fax:
Mailing address:
  • Phone: 501-364-3399
  • Fax: 501-364-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number66505
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-19475
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: