Healthcare Provider Details

I. General information

NPI: 1265530562
Provider Name (Legal Business Name): RICHARD D FRANK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 NE STEPHENS ST
ROSEBURG OR
97470
US

IV. Provider business mailing address

PO BOX 1700
ROSEBURG OR
97470-0414
US

V. Phone/Fax

Practice location:
  • Phone: 541-229-7038
  • Fax: 541-464-4474
Mailing address:
  • Phone: 541-229-7038
  • Fax: 541-464-4474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number098006599N1
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: