MEDICARE: DR. LLOYD MASON FRUGE MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	G5064	TX
2	207Q00000X	Family Medicine Physician	G5067	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	010018015	OTHER		MEDICARE RR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	117625	OTHER		CHIPS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	97278	OTHER	AR	BCBS
4	A0008	OTHER		CHAMPUS
5	806057	OTHER	TX	BCBS

NPI Number	:	1275547242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LLOYD MASON FRUGE MD

Provider Business Mailing Address
First Line	:	1011 S WILLIAM ST
Second Line	:
City	:	ATLANTA
State	:	TX
Zip	:	75551-3245
Country	:	US
Telephone Number	:	903-796-2868
Fax Number	:	903-796-0826

Provider Business Practice Location Address
First Line	:	1011 SOUTH WILLIAM
Second Line	:
City	:	ATLANTA
State	:	TX
Zip	:	75551-3245
Country	:	US
Telephone Number	:	903-796-2868
Fax Number	:	903-796-0826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	06/13/2024

1007 S WILLIAM ST
ATLANTA, TX
75551-3245

Practice Phone: 903-799-3326
Practice Fax:

1011 SOUTH WILLIAMS STREET
ATLANTA, TX
75551-3245