Basic Information
| Provider Information | |||||||||
| NPI: | 1114966603 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRANCIS | ||||||||
| FirstName: | JACK | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7500 GREENWAY CENTER DR | ||||||||
| Address2: | 8TH FLOOR | ||||||||
| City: | GREENBELT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207703502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014772000 | ||||||||
| FaxNumber: | 3014742389 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 GREENWAY CENTER DR | ||||||||
| Address2: | 8TH FLOOR | ||||||||
| City: | GREENBELT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207703502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014772000 | ||||||||
| FaxNumber: | 3014742389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 06/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | D0019191 | MD | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | MD9096 | DC | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 35301905 | 01 | BCBS MD GREENBELT OFFICE | OTHER | G02425M05 | 01 | MEDICARE | OTHER | 57620006 | 01 | BCBS DC | OTHER | 310891100 | 05 | MD | MEDICAID | 6179215 | 01 | CIGNA | OTHER | 432105237 | 01 | BRAVO HEALTH | OTHER | 1467381 | 01 | AETNA PPO | OTHER | 1901959 | 01 | UNITED HEALTHCARE AMERICHOICE | OTHER | 35301906 | 01 | BCBS MD BOWIE OFFICE | OTHER | 028039 | 01 | JOHN HOPKINS | OTHER | 028039 | 01 | PRIORITY PARTNERS | OTHER | 33112 | 01 | OPTIMUM CHOICE | OTHER | 353019507 | 01 | BCBS MD LAUREL OFFICE | OTHER | 4051788 | 01 | AETNA PPO | OTHER | P00439843 | 01 | MEDICARE RAILROAD | OTHER |