Provider Demographics
NPI:1558383729
Name:FROST, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 S UTICA AVE
Mailing Address - Street 2:PMB 217
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4909
Mailing Address - Country:US
Mailing Address - Phone:918-744-2618
Mailing Address - Fax:918-293-3188
Practice Address - Street 1:1515 N HARVARD AVE
Practice Address - Street 2:SUITE E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-4957
Practice Address - Country:US
Practice Address - Phone:918-832-6049
Practice Address - Fax:918-832-6055
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18346207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00405100OtherRR MEDICARE
OK100198140AMedicaid
OKP00405100OtherRR MEDICARE
OK247611806Medicare PIN