Healthcare Provider Details

I. General information

NPI: 1114144177
Provider Name (Legal Business Name): JOSEPH R FRANK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14810 OLD SAINT AUGUSTINE RD STE 106
JACKSONVILLE FL
32258-2558
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-268-7701
  • Fax: 904-390-7478
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-376-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD430046
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME140976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: