Basic Information
| Provider Information | |||||||||
| NPI: | 1841286762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRISINA | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 W INTERSTATE 20 | ||||||||
| Address2: | SUITE G 22 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760175870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177848268 | ||||||||
| FaxNumber: | 8178048176 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 W INTERSTATE 20 | ||||||||
| Address2: | STE G22 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760175870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177848268 | ||||||||
| FaxNumber: | 8178048176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 09/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | E5755 | TX | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 097376005 | 05 | TX | MEDICAID | P01338729 | 01 | TX | RAILROAD MEDICARE | OTHER | 097376003 | 05 | TX | MEDICAID | 097376001 | 05 | TX | MEDICAID | 097376004 | 01 | TX | MEDICAID OTHER | OTHER |