Provider Demographics
NPI:1154402451
Name:FRINK, EDWARD J JR (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:FRINK
Suffix:JR
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 1:20915 ROYAL OAK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:307-349-9570
Mailing Address - Fax:530-243-0445
Practice Address - Street 1:2865 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-882-6311
Practice Address - Fax:530-243-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7003A174400000X
ORMD182286207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY10227Medicare ID - Type UnspecifiedMEDICARE ID #