Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 1931 | AR |
N | 204E00000X | Oral & Maxillofacial Surgeon | 1931 | AR |
NPI | 1376691097 |
---|---|
Provider Name | Dr. Frank C Grammer |
First Address | Fayetteville, AR 72702-4185 |
Second Address | Fayetteville, AR 72703-5252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 04/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
194717 | UNITED CONCORDIA (01) | |
234282400 | DEPT OF LABOR WORKERS COM (01) | AR |
58229 | BCBS (01) | AR |
T20410 | (02) | AR |