Provider Demographics
NPI:1649236506
Name:FRISBEE, GARY LEE (DPM)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:FRISBEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1921
Mailing Address - Country:US
Mailing Address - Phone:419-756-1368
Mailing Address - Fax:419-774-0079
Practice Address - Street 1:770 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1921
Practice Address - Country:US
Practice Address - Phone:419-756-1368
Practice Address - Fax:419-774-0079
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36 001672213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0456402Medicaid
OH0412412Medicare ID - Type Unspecified
OHT96087Medicare UPIN