Provider Demographics
NPI:1407453145
Name:FROGLEY, IAN
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:FROGLEY
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 1:2236 OAK LN
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-7894
Mailing Address - Country:US
Mailing Address - Phone:435-799-4005
Mailing Address - Fax:
Practice Address - Street 1:JBSA 2230 HUGHES AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236-8404
Practice Address - Country:US
Practice Address - Phone:435-799-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians