MEDICARE: PHILIP RANDALL FRANK D.O.

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	2084P0800X	Psychiatry Physician	DO22957	OR
2	2084P0800X	Psychiatry Physician	OP00002302	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4763FR	OTHER	WA	REGENCE
2	0256897	OTHER	WA	L&I AND CRIME VICTIMS
3	7113382	OTHER	WA	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982677928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP RANDALL FRANK D.O.

Provider Business Mailing Address
First Line	:	1602 WILBUR RD SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-3626
Country	:	US
Telephone Number	:	541-913-5971
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 WILBUR RD SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-3626
Country	:	US
Telephone Number	:	540-988-4150
Fax Number	:

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	11/28/2018

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