Healthcare Provider Details

I. General information

NPI: 1013910421
Provider Name (Legal Business Name): PAUL FREDERICK FRANCKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 LEE ST E STE 203
CHARLESTON WV
25301-1864
US

IV. Provider business mailing address

1220 LEE ST E STE 203
CHARLESTON WV
25301-1864
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-4124
  • Fax: 304-343-4167
Mailing address:
  • Phone: 304-343-4124
  • Fax: 304-343-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number12293
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: