Basic Information
Provider Information | |||||||||
NPI: | 1316382583 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FRANKE | ||||||||
FirstName: | EVAN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 20280 N 59TH AVE | ||||||||
Address2: | # 115-617 | ||||||||
City: | GLENDALE | ||||||||
State: | AZ | ||||||||
PostalCode: | 853086850 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6027958700 | ||||||||
FaxNumber: | 6027958701 | ||||||||
Practice Location | |||||||||
Address1: | 2222 E HIGHLAND AVE STE 220 | ||||||||
Address2: |   | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850164876 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6023515985 | ||||||||
FaxNumber: | 6027958701 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/01/2013 | ||||||||
LastUpdateDate: | 12/31/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/31/2019 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | R73764 | AZ | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 208VP0000X | 49551 | AZ | Y |   | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.