Provider Demographics
NPI:1255337846
Name:FRISCO, DONALD JEROME (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JEROME
Last Name:FRISCO
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 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-226-2663
Mailing Address - Fax:605-226-0095
Practice Address - Street 1:701 8TH AVE NW
Practice Address - Street 2:STE A
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1803
Practice Address - Country:US
Practice Address - Phone:605-226-2663
Practice Address - Fax:605-226-0095
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4415208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6400970Medicaid
SDG17498Medicare UPIN
ND20227Medicare PIN
SD6400970Medicaid
SD1108470001Medicare NSC
SD260036368Medicare PIN