Provider Demographics
NPI:1417042912
Name:MESDAG, FRANK FIR (FRANK MESDAG)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:FIR
Last Name:MESDAG
Suffix:
Gender:M
Credentials:FRANK MESDAG
Other - Prefix:DR
Other - First Name:FEIKO
Other - Middle Name:FIR
Other - Last Name:MESDAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FRANK MESDAG
Mailing Address - Street 1:P.O. BOX 32497
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-2497
Mailing Address - Country:US
Mailing Address - Phone:907-790-3586
Mailing Address - Fax:907-790-3335
Practice Address - Street 1:8800 GLACIER HIGHWAY
Practice Address - Street 2:SUITE 218
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8080
Practice Address - Country:US
Practice Address - Phone:907-789-0405
Practice Address - Fax:907-789-2925
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA1612213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPD1612Medicaid
AK0000SGBFCMedicare ID - Type Unspecified
AKPD1612Medicaid