MEDICARE: DR. FRANK ROBERT GENCO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	J3478	TX
2	207P00000X	Emergency Medicine Physician	J3478	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8W1460	OTHER	TX	BCBSTX PROVIDER ID
2	J3478	OTHER	TX	MEDICAL LICENSE #

General Provider Information

NPI Number	:	1467525808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK ROBERT GENCO M.D.

Provider Business Mailing Address
First Line	:	1104 JOHN MCCAIN RD
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-6315
Country	:	US
Telephone Number	:	817-503-8800
Fax Number	:	817-503-8801

Provider Business Practice Location Address
First Line	:	8245 PRECINCT LINE RD
Second Line	:	SUITE 100
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-1672
Country	:	US
Telephone Number	:	817-503-8800
Fax Number	:	817-503-8801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	06/05/2017

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