Healthcare Provider Details

I. General information

NPI: 1477668564
Provider Name (Legal Business Name): DENNIS J FRIESEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 W 3RD ST SUITE 103B
ELK CITY OK
73644-5159
US

IV. Provider business mailing address

206 GROVE AVE
ELK CITY OK
73644-2402
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-8600
  • Fax: 580-225-8601
Mailing address:
  • Phone: 580-225-8600
  • Fax: 580-225-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10504
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: