Provider Demographics
NPI:1417083965
Name:FAMILY DOCTOR MEDICAL GROUP
Entity Type:Organization
Organization Name:FAMILY DOCTOR MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-745-4348
Mailing Address - Street 1:160 E N ST
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2734
Mailing Address - Country:US
Mailing Address - Phone:707-745-9211
Mailing Address - Fax:707-745-3015
Practice Address - Street 1:160 E N ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2734
Practice Address - Country:US
Practice Address - Phone:707-745-9211
Practice Address - Fax:707-745-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25971207Q00000X
CAA499399207Q00000X
CAPA16645207Q00000X
CAA88568207R00000X
CAA47981207RC0000X
CAA57270207RE0101X
CAC42256207V00000X
CAC41918207V00000X
CAH70813207V00000X
CAA27248207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 16645OtherLORELEE SCIPIONE, PA
CAA27248Medicare UPIN
CAA27248F2Medicare UPIN
CAH70813Medicare UPIN
CAT10937Medicare UPIN
CAA89427Medicare UPIN
CAA89129Medicare UPIN
CAA37704Medicare UPIN
CAA57270Medicare UPIN
CAA88568Medicare UPIN
CAPA 16645OtherLORELEE SCIPIONE, PA