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General NPI Number Information
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NPI Number | 1780129858
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Entity Type | Individual
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Provider Name | MARK EDWIN FRISSE
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Gender | Male
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 3707 WIMBLEDON RD
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City | NASHVILLE
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State | TN
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Zip | 37215-1819
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Country | US
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Telephone | 615-720-7761
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Fax | 615-936-0102
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Provider Business Mailing Address
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Address Line | 3707 WIMBLEDON RD
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City | NASHVILLE
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State | TN
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Zip | 37215-1819
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Country | US
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Telephone | 615-720-7761
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Fax | 615-936-0102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R3A00
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License Number State | MO
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