Provider Demographics
NPI:1487043444
Name:PHARES, FRANKLEN JR
Entity Type:Individual
Prefix:MR
First Name:FRANKLEN
Middle Name:
Last Name:PHARES
Suffix:JR
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 1:1827 MCGREGOR AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5535
Mailing Address - Country:US
Mailing Address - Phone:817-885-9893
Mailing Address - Fax:
Practice Address - Street 1:1827 MCGREGOR AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5535
Practice Address - Country:US
Practice Address - Phone:817-885-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT5979390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program