Provider Demographics
NPI:1083662043
Name:FROST, JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:FROST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 MILLERSPORT HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1219
Mailing Address - Country:US
Mailing Address - Phone:716-204-5933
Mailing Address - Fax:716-204-5934
Practice Address - Street 1:1829 MAPLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2700
Practice Address - Country:US
Practice Address - Phone:716-204-5933
Practice Address - Fax:716-204-5934
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY175695-1207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01348374Medicaid
NY01348374Medicaid
BB0229Medicare ID - Type Unspecified