Provider Demographics
NPI:1437102126
Name:FRICKMAN, CARL ELMO (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:ELMO
Last Name:FRICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 W EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-9176
Mailing Address - Country:US
Mailing Address - Phone:970-669-2849
Mailing Address - Fax:970-669-5436
Practice Address - Street 1:3320 W EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-9176
Practice Address - Country:US
Practice Address - Phone:970-669-2849
Practice Address - Fax:970-669-5436
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01270859Medicaid
CO01270859Medicaid