Healthcare Provider Details

I. General information

NPI: 1962460519
Provider Name (Legal Business Name): DOUGLAS LYNN FRIESEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 S RIFE MEDICAL LN STE T40
ROGERS AR
72758-1474
US

IV. Provider business mailing address

PO BOX 1515
DURANT OK
74702-1515
US

V. Phone/Fax

Practice location:
  • Phone: 479-878-2550
  • Fax: 479-878-2555
Mailing address:
  • Phone: 580-920-2525
  • Fax: 580-924-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberN8205
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: