MEDICARE: DR. FREDDY DWIGHT CHRISMAN MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	E2165	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CC6745	OTHER	AR	RAILROAD MEDICARE
4	CN1884	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5M816	OTHER	AR	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649241258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDDY DWIGHT CHRISMAN MD

Provider Business Mailing Address
First Line	:	9501 LILE DR
Second Line	:	SUITE 600
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6225
Country	:	US
Telephone Number	:	501-227-7596
Fax Number	:	501-227-7787

Provider Business Practice Location Address
First Line	:	9501 LILE DR
Second Line	:	SUITE 600
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6225
Country	:	US
Telephone Number	:	501-227-7596
Fax Number	:	501-227-7787

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	10/04/2011

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Directions to “ DR. FREDDY DWIGHT CHRISMAN MD” Practice Location

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