Provider Demographics
NPI:1841286762
Name:FRISINA, CARL I (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:I
Last Name:FRISINA
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 1:811 W INTERSTATE 20
Mailing Address - Street 2:SUITE G 22
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5870
Mailing Address - Country:US
Mailing Address - Phone:817-784-8268
Mailing Address - Fax:817-804-8176
Practice Address - Street 1:811 W INTERSTATE 20
Practice Address - Street 2:STE G22
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5870
Practice Address - Country:US
Practice Address - Phone:817-784-8268
Practice Address - Fax:817-804-8176
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5755208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097376005Medicaid
TXP01338729OtherRAILROAD MEDICARE
TX097376003Medicaid
TX097376001Medicaid
TX097376004OtherMEDICAID OTHER
TX097376003Medicaid
TXB22793Medicare UPIN
TX097376004OtherMEDICAID OTHER