MEDICARE: TERRIE LYNN FRANKENFIELD R

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247100000X	Radiologic Technologist	48898	FL

General Provider Information

NPI Number	:	1053345264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRIE LYNN FRANKENFIELD R

Provider Business Mailing Address
First Line	:	2309 MINNESOTA AVE
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-4810
Country	:	US
Telephone Number	:	850-271-6195
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 E 23RD ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-5307
Country	:	US
Telephone Number	:	850-747-8822
Fax Number	:	850-747-8664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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