Provider Demographics
NPI:1679681860
Name:FRANKS, WILLIAM DALE JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DALE
Last Name:FRANKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:W.
Other - Middle Name:DALE
Other - Last Name:FRANKS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2600 GRAND AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5375
Mailing Address - Country:US
Mailing Address - Phone:515-249-8448
Mailing Address - Fax:
Practice Address - Street 1:2600 GRAND AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5375
Practice Address - Country:US
Practice Address - Phone:515-249-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35038208200000X, 2086S0122X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3290817Medicaid
IA2290817Medicaid
IA1290817Medicaid
IA2290817Medicaid
IAI15339Medicare ID - Type Unspecified