Frost, Edward Fairfax

Frost, Edward Fairfax is an individual health care provider with primary practice located at 109 Air Park Dr Prohealth Care Medical Associates Inc., Watertown WI 53094-7400. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Frost, Edward Fairfax can be contacted via phone (262) 928-5100.

Contact Information

Primary practice address
109 Air Park Dr Prohealth Care Medical Associates Inc. Watertown WI 53094-7400
Phone: (262) 928-5100
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 52228 Wisconsin
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 52228 Wisconsin

Profile Details

NPI number 1184698227
LBN Legal business name Frost, Edward Fairfax
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 15th, 2006
Last updated Jul 11th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184698227 NPPES
New York MEDICAID 02271603

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