Provider Demographics
NPI:1568501245
Name:FRANK, BENNETT DAVID (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:DAVID
Last Name:FRANK
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:969 N MASON RD STE 155
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6387
Mailing Address - Country:US
Mailing Address - Phone:314-628-9990
Mailing Address - Fax:314-628-9992
Practice Address - Street 1:969 N MASON RD STE 155
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6387
Practice Address - Country:US
Practice Address - Phone:314-628-9990
Practice Address - Fax:314-628-9992
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO369442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF33723Medicare UPIN