Provider Demographics
NPI:1245786177
Name:DEFRANGE, JOSEPH JAMES
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:DEFRANGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 W DOROTHY JEANNE ST APT 9
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-8704
Mailing Address - Country:US
Mailing Address - Phone:918-916-2075
Mailing Address - Fax:
Practice Address - Street 1:3005 W DOROTHY JEANNE ST APT 9
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-8704
Practice Address - Country:US
Practice Address - Phone:918-916-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator