Provider Demographics
NPI:1093710998
Name:ARCHER, FRANK J (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:J
Last Name:ARCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-0008
Mailing Address - Country:US
Mailing Address - Phone:801-798-5359
Mailing Address - Fax:385-888-9171
Practice Address - Street 1:24 N 100 E
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1802
Practice Address - Country:US
Practice Address - Phone:801-465-4896
Practice Address - Fax:801-465-3267
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4253A207Q00000X
UT6701075-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114390500Medicaid
WY308485OtherBCBS
WYW308485Medicare PIN
WYG95186Medicare UPIN
WY308485OtherBCBS