Healthcare Provider Details

I. General information

NPI: 1013473800
Provider Name (Legal Business Name): MCKAY FRANDSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2019
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GAFFNEY RD
FT WAINWRIGHT AK
99703-5002
US

IV. Provider business mailing address

4076 NEELY ROAD BLDG 4076, ROOM 1B-201
FORT WAINWRIGHT AK
99703
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-5644
  • Fax: 907-361-4823
Mailing address:
  • Phone: 907-361-6028
  • Fax: 907-361-4847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102206480
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number217300
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: