Provider Demographics
NPI:1164530226
Name:JACQUELYN S. FRIGON, M.D., P.A.
Entity Type:Organization
Organization Name:JACQUELYN S. FRIGON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRIGON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-535-4800
Mailing Address - Street 1:1801 W 40TH AVE
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6940
Mailing Address - Country:US
Mailing Address - Phone:870-535-4800
Mailing Address - Fax:870-535-4804
Practice Address - Street 1:1801 W 40TH AVE
Practice Address - Street 2:SUITE 5B
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6940
Practice Address - Country:US
Practice Address - Phone:870-535-4800
Practice Address - Fax:870-535-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2808208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103056001Medicaid
AR51797Medicare PIN
AR103056001Medicaid