Healthcare Provider Details

I. General information

NPI: 1205976412
Provider Name (Legal Business Name): PATRICK CLAUDE FRISBEE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E MAIN ST
LAKE BUTLER FL
32054-1353
US

IV. Provider business mailing address

431 HANSON AVE
ORANGE PARK FL
32065-6739
US

V. Phone/Fax

Practice location:
  • Phone: 386-496-2323
  • Fax:
Mailing address:
  • Phone: 904-708-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9100670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: