Healthcare Provider Details

I. General information

NPI: 1629044144
Provider Name (Legal Business Name): PETER R DEFRANK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7709 ALTO CARO DR
DALLAS TX
75248-4303
US

IV. Provider business mailing address

7709 ALTO CARO DR
DALLAS TX
75248-4303
US

V. Phone/Fax

Practice location:
  • Phone: 214-866-5313
  • Fax: 972-947-3976
Mailing address:
  • Phone: 214-866-5313
  • Fax: 972-947-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0866
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0866
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: