Healthcare Provider Details

I. General information

NPI: 1245270776
Provider Name (Legal Business Name): LOUIS JAY FRANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LOUIS JAY FRANK M.D.

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PORTLAND ST - SUITE 6
ST JOHNSBURY VT
05819
US

IV. Provider business mailing address

P.O. BOX 187
ST JOHNSBURY VT
05819
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-9000
  • Fax: 802-748-9031
Mailing address:
  • Phone: 802-748-9000
  • Fax: 802-748-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number42-0006770
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: