Provider Demographics
NPI:1962460519
Name:FRIESEN, DOUGLAS LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LYNN
Last Name:FRIESEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-1515
Mailing Address - Country:US
Mailing Address - Phone:580-920-2525
Mailing Address - Fax:580-924-2305
Practice Address - Street 1:2708 S RIFE MEDICAL LN STE T40
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1474
Practice Address - Country:US
Practice Address - Phone:479-878-2550
Practice Address - Fax:479-878-2555
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121430001Medicaid
AR55443Medicare ID - Type Unspecified
AR121430001Medicaid