Healthcare Provider Details

I. General information

NPI: 1619137064
Provider Name (Legal Business Name): JOSHUA C FRONK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR ROOM HC005 MC 5277
STANFORD CA
94305-2200
US

IV. Provider business mailing address

1215 WELCH RD MODULAR H MC5408
STANFORD CA
94305-5102
US

V. Phone/Fax

Practice location:
  • Phone: 650-724-0385
  • Fax: 650-497-7056
Mailing address:
  • Phone: 650-723-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11771
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number20A 11771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: