Provider Demographics
NPI:1649229030
Name:FROEMMING, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:FROEMMING
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:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-0036
Mailing Address - Country:US
Mailing Address - Phone:334-393-8700
Mailing Address - Fax:
Practice Address - Street 1:400 N EDWARDS ST
Practice Address - Street 2:ANESTHESIA DEPT.
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2510
Practice Address - Country:US
Practice Address - Phone:334-393-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9254207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911139Medicaid
AL051540783OtherBCBS OF AL
AL51514780OtherBLUE SHIELD
AL051522937Medicaid
AL051514780Medicaid
AL51522937OtherBLUE SHIELD
P00134987OtherPALMETTO GBA
AL051522937Medicare ID - Type Unspecified
AL051522937Medicaid
C71420Medicare UPIN
AL51522937OtherBLUE SHIELD