Basic Information
| Provider Information | |||||||||
| NPI: | 1720139892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRANK | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 COMMERICAL STREET | ||||||||
| Address2: | |||||||||
| City: | LEAVENWORTH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988261316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083348015 | ||||||||
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| Practice Location | |||||||||
| Address1: | 281 LINCOLN ST | ||||||||
| Address2: | MED STAFF SVCS | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083348015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 10/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD60070594 | WA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 208600000X | 234147 | MA | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8533333 | 05 | WA | MEDICAID |