Healthcare Provider Details

I. General information

NPI: 1912092370
Provider Name (Legal Business Name): EUGENE L FRANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 PASEO ENCANTADO SW
TESUQUE NM
87574
US

IV. Provider business mailing address

PO BOX 179
TESUQUE NM
87574-0179
US

V. Phone/Fax

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

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:
Title or Position:
Credential:
Phone: