Basic Information
| Provider Information | |||||||||
| NPI: | 1609873785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRANCKE | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4708 OLEANDER DR | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295775742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434499415 | ||||||||
| FaxNumber: | 8434492160 | ||||||||
| Practice Location | |||||||||
| Address1: | 2234 COLONIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 11/21/2016 | ||||||||
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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 | 2085R0001X | ME0077442 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | TL33194 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 256933700 | 05 | FL | MEDICAID | 5912832 | 05 | NC | MEDICAID | P00900588 | 01 | SC | RAILROAD MEDICARE | OTHER | 167847 | 01 | FL | WELLCARE PROVIDER NUMBER | OTHER | 4608762-005 | 01 | FL | CIGNA PROVIDER # | OTHER | 8889 | 01 | FL | DIMENSION HLTH. PROV. # | OTHER | 259924 | 01 | FL | AVMED PROVIDER NUMBER | OTHER | 331947 | 05 | SC | MEDICAID | 8792 | 01 | FL | TOTAL HLTH CH. PROVIDER # | OTHER | 32252 | 01 | FL | NHP THRU PMG PROVIDER # | OTHER | 5338095 | 01 | SC | AETNA | OTHER | 80023849 | 01 | SC | SELECT HEALTH | OTHER | 000000388210 | 01 | SC | UNITED HEALTHCARE COMMUNITY PLAN (UNISON) | OTHER | 239338 | 01 | FL | AMERIGROUP PROVIDER NUM. | OTHER | 905189 | 01 | FL | FIRST HEALTH PROVIDER # | OTHER | 46780 | 01 | FL | BCBS PROVIDER NUMBER | OTHER | 1542J | 01 | NC | BCBS | OTHER | 5338095 | 01 | FL | AETNA PROVIDER NUMBER | OTHER | 7200427 | 01 | FL | GHI PROVIDER NUMBER | OTHER | 774386 | 01 | SC | WELLCARE | OTHER |