Provider Demographics
NPI:1053498717
Name:FROBERG, LARRY MICHAEL
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:MICHAEL
Last Name:FROBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 HICKORY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2515
Mailing Address - Country:US
Mailing Address - Phone:501-868-8446
Mailing Address - Fax:
Practice Address - Street 1:4300 W 7TH STREET
Practice Address - Street 2:JOHN L. MCCLELLEN MEMORIAL VETERANS HOSPITAL
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-257-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5064207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology