Provider Demographics
NPI:1720085517
Name:FRENTZ, BRYAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:G
Last Name:FRENTZ
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 490
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0490
Mailing Address - Country:US
Mailing Address - Phone:601-250-4366
Mailing Address - Fax:601-250-4367
Practice Address - Street 1:300 RAWLS DR STE 500
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2899
Practice Address - Country:US
Practice Address - Phone:601-249-4282
Practice Address - Fax:601-249-4852
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024773207X00000X
MS22089207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00253396OtherPALMETTO GBA - RAILROAD M
LA1579475Medicaid
LAP00253396OtherPALMETTO GBA - RAILROAD M
LAI32779Medicare UPIN
LA4J6597191Medicare PIN