Healthcare Provider Details

I. General information

NPI: 1326030966
Provider Name (Legal Business Name): FRANK DOMINIC CIRISANO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 LINTON BLVD STE 216
DELRAY BEACH FL
33484-6516
US

IV. Provider business mailing address

PO BOX 7957
DELRAY BEACH FL
33482-7957
US

V. Phone/Fax

Practice location:
  • Phone: 561-447-0090
  • Fax: 561-447-9663
Mailing address:
  • Phone: 561-447-0090
  • Fax: 561-447-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME0074132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: