MEDICARE: FRONTIER MEDICAL GROUP INC.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	A100982	CA

General Provider Information

NPI Number	:	1902191125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONTIER MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	1016 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1505
Country	:	US
Telephone Number	:	310-652-9283
Fax Number	:	310-652-9292

Provider Business Practice Location Address
First Line	:	1016 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1505
Country	:	US
Telephone Number	:	310-652-9283
Fax Number	:	310-652-9292

Authorized Official
Title or Position	:	GENERAL PRACTICE
Name	:	DR. DANIEL DRAKE
Credential	:	MD.
Telephone Number	:	310-652-9283

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/15/2011

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