Provider Demographics
NPI:1205822384
Name:FRAKER, JOHN TEMPLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TEMPLE
Last Name:FRAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4902 EISENHOWER BLVD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6344
Mailing Address - Country:US
Mailing Address - Phone:813-636-2000
Mailing Address - Fax:813-286-8835
Practice Address - Street 1:4211 VANDYKE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8002
Practice Address - Country:US
Practice Address - Phone:813-264-6490
Practice Address - Fax:813-286-8835
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME72120207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023179886Medicaid
FLF51625Medicare UPIN
FL32555XMedicare PIN