Provider Demographics
NPI:1205866795
Name:MAYER, FRANK JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:JOSEPH
Last Name:MAYER
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 1:575 RIVER GATE LANE
Mailing Address - Street 2:#209
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-259-0440
Mailing Address - Fax:970-259-7091
Practice Address - Street 1:575 RIVER GATE LANE
Practice Address - Street 2:#209
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-259-0440
Practice Address - Fax:970-259-7091
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32798208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01327980Medicaid
F62309Medicare UPIN
COC497728Medicare PIN