Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101045554 | VA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 0101045554 | VA |
NPI | 1275587537 |
---|---|
Provider Name | Thomas George Franck |
First Address | North Chesterfield, VA 23225-4067 |
Second Address | Richmond, VA 23294-4373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 18/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1275587537 | (05) | VA |
P00761608 | RR MEDICARE (01) | VA |