Provider Demographics
NPI:1356339311
Name:FRINK, TIMOTHY J (DO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:FRINK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 ROCKEFELLER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5056
Mailing Address - Country:US
Mailing Address - Phone:918-684-4393
Mailing Address - Fax:918-684-9096
Practice Address - Street 1:101 ROCKEFELLER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5056
Practice Address - Country:US
Practice Address - Phone:918-684-4393
Practice Address - Fax:918-684-9096
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3518207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100002710AMedicaid
OK2143552OtherUNITED HEALTHCARE
OK7521116OtherAETNA
OK100002710AMedicaid
OKP00264738Medicare PIN
OK7521116OtherAETNA