Provider Demographics
NPI:1205818051
Name:FRANK, BRADLEY H (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:H
Last Name:FRANK
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 1:2912 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1974
Mailing Address - Country:US
Mailing Address - Phone:928-774-3627
Mailing Address - Fax:928-774-1400
Practice Address - Street 1:2912 N WEST ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1974
Practice Address - Country:US
Practice Address - Phone:928-774-3627
Practice Address - Fax:928-774-1400
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ472910OtherAHCCCS
AZ472910OtherAHCCCS
AZZ71577Medicare ID - Type Unspecified