Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0102206480 | VA |
NPI | 1013473800 |
---|---|
Provider Name | Dr. Mckay Frandsen |
First Address | Jbsa Ft Sam Houston, TX 78234-4504 |
Second Address | Jbsa Ft Sam Houston, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2019 |
Last Update Date | 12/02/2021 |