Provider Demographics
NPI:1043208879
Name:FRISBIE, STEPHANIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:E
Last Name:FRISBIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5830
Mailing Address - Country:US
Mailing Address - Phone:479-474-5061
Mailing Address - Fax:479-922-2007
Practice Address - Street 1:620 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5830
Practice Address - Country:US
Practice Address - Phone:479-474-5061
Practice Address - Fax:479-922-2007
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137766001Medicaid
OK200014700AMedicaid
ARE2242OtherARKANSAS STATE LICENSE
AR5L241OtherBLUE CROSS
AR04D1061540OtherCLIA
AR04D1061540OtherCLIA
AR137766001Medicaid
ARBF4135768OtherDEA