Provider Demographics
NPI:1700888906
Name:FROHN, WILLIAM ERIC (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ERIC
Last Name:FROHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:ERIC
Other - Last Name:FROHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:236 STARLYN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-2428
Mailing Address - Country:US
Mailing Address - Phone:662-534-4121
Mailing Address - Fax:662-534-4172
Practice Address - Street 1:236 STARLYN AVE
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-2428
Practice Address - Country:US
Practice Address - Phone:662-534-4121
Practice Address - Fax:662-534-4172
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-04-25
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MS17785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016207Medicaid
MSG64326Medicare UPIN
MS160000545Medicare PIN