Healthcare Provider Details

I. General information

NPI: 1154646636
Provider Name (Legal Business Name): EUGENE L. FRANK MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 PASEO ENCANTADO SW
TESUQUE NM
87574-0179
US

IV. Provider business mailing address

PO BOX 170
TESUQUE NM
87574-0170
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-9190
  • Fax: 505-983-9190
Mailing address:
  • Phone: 505-983-9190
  • Fax: 505-983-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number92-223
License Number StateNM

VIII. Authorized Official

Name: EUGENE L. FRANK
Title or Position: SOLE PROPRIETOR
Credential: MD LLC
Phone: 505-983-9190