Provider Demographics
NPI:1730502071
Name:FRIGON, GARY F (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:F
Last Name:FRIGON
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 1:7 FRENSHAM LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-6900
Mailing Address - Country:US
Mailing Address - Phone:479-381-6362
Mailing Address - Fax:
Practice Address - Street 1:7 FRENSHAM LN
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-6900
Practice Address - Country:US
Practice Address - Phone:479-381-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113363001Medicaid
ARD04452Medicare UPIN
AR51094Medicare PIN