Provider Demographics
NPI:1790713402
Name:SCALISE, FRANK (PAC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:SCALISE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2111 CHAMPA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2529
Mailing Address - Country:US
Mailing Address - Phone:303-293-2220
Mailing Address - Fax:303-293-3977
Practice Address - Street 1:2100 BROADWAY
Practice Address - Street 2:STOUT STREET CLINIC
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2526
Practice Address - Country:US
Practice Address - Phone:303-293-2220
Practice Address - Fax:303-293-3977
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO0240363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical