Provider Demographics
NPI:1407987456
Name:FROST, JOSEPH THOMAS (RD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:THOMAS
Last Name:FROST
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:THOMAS
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:2960 TONGASS AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5742
Mailing Address - Country:US
Mailing Address - Phone:907-228-4902
Mailing Address - Fax:907-228-5256
Practice Address - Street 1:2960 TONGASS AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5742
Practice Address - Country:US
Practice Address - Phone:907-228-4902
Practice Address - Fax:907-228-5256
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001355133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK888820OtherCDR