Provider Demographics
NPI:1649241258
Name:CHRISMAN, FREDDY DWIGHT (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDDY
Middle Name:DWIGHT
Last Name:CHRISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9501 LILE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6225
Mailing Address - Country:US
Mailing Address - Phone:501-227-7596
Mailing Address - Fax:501-227-7787
Practice Address - Street 1:9501 LILE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6225
Practice Address - Country:US
Practice Address - Phone:501-227-7596
Practice Address - Fax:501-227-7787
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE2165207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M816OtherBLUE CROSS BLUE SHIELD
ARCC6745OtherRAILROAD MEDICARE
AR154191001Medicaid
ARCN1884OtherRAILROAD MEDICARE
ARCN1884OtherRAILROAD MEDICARE
I04275Medicare UPIN