Provider Demographics
NPI:1376851543
Name:DONALD P FRUSHER PA
Entity Type:Organization
Organization Name:DONALD P FRUSHER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FRUSHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-504-4824
Mailing Address - Street 1:88 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-2972
Mailing Address - Country:US
Mailing Address - Phone:817-267-0550
Mailing Address - Fax:817-545-2368
Practice Address - Street 1:88 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-2972
Practice Address - Country:US
Practice Address - Phone:817-267-0550
Practice Address - Fax:817-545-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5531261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124087044OtherNPI INDIVIDUAL
TXG78224Medicare UPIN