Healthcare Provider Details

I. General information

NPI: 1467495374
Provider Name (Legal Business Name): ERIC ANDREW FRANCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/22/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4206 SW IDAHO TER
PORTLAND OR
97221-3362
US

IV. Provider business mailing address

4206 SW IDAHO TER
PORTLAND OR
97221-3362
US

V. Phone/Fax

Practice location:
  • Phone: 904-707-5689
  • Fax: 904-707-5689
Mailing address:
  • Phone: 904-707-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG81592
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME95492
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number52778-20
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD161240
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: