Provider Demographics
NPI:1093027591
Name:CHRIS FRANKLIN DO PC
Entity Type:Organization
Organization Name:CHRIS FRANKLIN DO PC
Other - Org Name:LAKE AREA CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-346-4446
Mailing Address - Street 1:948 EAST US HWY 54
Mailing Address - Street 2:P.O. BOX 1380
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-1380
Mailing Address - Country:US
Mailing Address - Phone:573-346-4446
Mailing Address - Fax:573-346-2975
Practice Address - Street 1:948 EAST US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6834
Practice Address - Country:US
Practice Address - Phone:573-346-4446
Practice Address - Fax:573-346-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000094814OtherMEDICARE PTAN
MO241797224Medicaid
MOE12320Medicare UPIN