Healthcare Provider Details

I. General information

NPI: 1982608600
Provider Name (Legal Business Name): FRANK ROBERT WALCHAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W. 5TH AVE.
SPOKANE WA
99204
US

IV. Provider business mailing address

PO BOX 8500 LOCKBOX 7642
PHILADELPHIA PA
19178-7642
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-7844
  • Fax: 509-623-0415
Mailing address:
  • Phone: 813-281-8115
  • Fax: 813-281-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD00015543
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: