Provider Demographics
NPI:1730316043
Name:FRANDSEN, DEVN A (DO)
Entity Type:Individual
Prefix:DR
First Name:DEVN
Middle Name:A
Last Name:FRANDSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 ARDEN DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7904
Mailing Address - Country:US
Mailing Address - Phone:435-770-2888
Mailing Address - Fax:845-698-8293
Practice Address - Street 1:2730 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5049
Practice Address - Country:US
Practice Address - Phone:208-542-7100
Practice Address - Fax:208-542-7150
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT100581207Q00000X, 2083P0011X
WI66769-21207Q00000X
PAOS017304207Q00000X
IL036 131300207Q00000X
ARE-7208207Q00000X
WI66769207Q00000X
IDO-08422083P0011X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1730316043Medicaid
MT1730316043Medicaid
WI1730316043Medicaid