Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 174468-1205 | UT |
NPI | 1003854324 |
---|---|
Provider Name | Tracy M Frandsen |
First Address | Spanish Fork, UT 84660-2060 |
Second Address | Spanish Fork, UT 84660-2060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08429 | (05) | UT |
C63876 | (02) | UT |