Healthcare Provider Details

I. General information

NPI: 1124202536
Provider Name (Legal Business Name): CHARLES E. FRANKUM, JR, MD, PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 OGDEN ST SUITE 530
DENVER CO
80218-3666
US

IV. Provider business mailing address

1960 OGDEN ST SUITE 530
DENVER CO
80218-3666
US

V. Phone/Fax

Practice location:
  • Phone: 303-830-2004
  • Fax: 303-318-2604
Mailing address:
  • Phone: 303-830-2004
  • Fax: 303-318-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39773
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number39773
License Number StateCO

VIII. Authorized Official

Name: JULIE A WANCIK
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-830-2004