Provider Demographics
NPI:1184669277
Name:FRIZELL, GARRY G (CRNA)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:G
Last Name:FRIZELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 N FLORA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-4103
Mailing Address - Country:US
Mailing Address - Phone:559-448-9034
Mailing Address - Fax:559-439-0223
Practice Address - Street 1:6425 N FLORA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-4103
Practice Address - Country:US
Practice Address - Phone:559-448-9034
Practice Address - Fax:559-439-0223
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA1147367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANA0011470OtherBLUE SHIELD OF CA
CARN2575960Medicaid
CAS53813Medicare UPIN
CAZZZ31864ZMedicare ID - Type Unspecified
CAZZZ04723ZMedicare PIN