Healthcare Provider Details

I. General information

NPI: 1205822384
Provider Name (Legal Business Name): JOHN TEMPLE FRAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VANDYKE ROAD SUITE 200
LUTZ FL
33558-8002
US

IV. Provider business mailing address

4902 EISENHOWER BLVD. SUITE 300
TAMPA FL
33634-6344
US

V. Phone/Fax

Practice location:
  • Phone: 813-264-6490
  • Fax: 813-286-8835
Mailing address:
  • Phone: 813-636-2000
  • Fax: 813-286-8835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME72120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: