Provider Demographics
NPI:1033179163
Name:FRYXELL, ERIC ELLIS (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ELLIS
Last Name:FRYXELL
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 1:1180 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1902
Mailing Address - Country:US
Mailing Address - Phone:614-645-1900
Mailing Address - Fax:614-645-5517
Practice Address - Street 1:1180 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1902
Practice Address - Country:US
Practice Address - Phone:614-645-5535
Practice Address - Fax:614-645-5546
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-077709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2173713Medicaid
OH341425870042OtherMEDICAL MUTUAL OF OHIO
OH264200000OtherFEDERAL BLACK LUNG
OH000000341594OtherANTHEM
OH80507OtherQUALCHOICE
OH6600162OtherUNITED HEALTHCARE
OH264200000OtherDEPT OF LABOR
OH264200000OtherFEDERAL BLACK LUNG
OHG80097Medicare UPIN
OHFR4139512Medicare ID - Type Unspecified