Provider Demographics
NPI:1275512642
Name:FRIGON MD PA, JACQUELYN SUE
Entity Type:Individual
Prefix:
First Name:JACQUELYN SUE
Middle Name:
Last Name:FRIGON MD PA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W 40TH AVE
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6900
Mailing Address - Country:US
Mailing Address - Phone:870-535-4800
Mailing Address - Fax:870-535-4804
Practice Address - Street 1:1801 W 40TH AVE
Practice Address - Street 2:SUITE 5B
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6900
Practice Address - Country:US
Practice Address - Phone:870-535-4800
Practice Address - Fax:870-535-4804
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103056001Medicaid
ARD79434Medicare UPIN
AR51797Medicare ID - Type Unspecified