Provider Demographics
NPI:1861474520
Name:DE MAYO, FRANK MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:MICHAEL
Last Name:DE MAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:793 S TRACY BLVD STE 332
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4753
Mailing Address - Country:US
Mailing Address - Phone:209-835-4888
Mailing Address - Fax:209-835-6424
Practice Address - Street 1:530 W EATON AVE STE E
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3455
Practice Address - Country:US
Practice Address - Phone:209-835-4888
Practice Address - Fax:209-835-6424
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60003207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA503775OtherHEALTH NET
CA027703OtherHILL PHYSICIANS
CA171739500OtherUS DEPARTEMENT OF LABOR
CA50215OtherINTERPLAN
CAZZZ59760ZOtherBLUE SHIELD
CA200033549OtherMEDICARE RAILROAD
CAG00060003OtherBLUE CROSS
CA00004OtherUNITED HEALTHCARE
CA4230532OtherAETNA
CA200033549OtherMEDICARE RAILROAD
CAG00060003OtherBLUE CROSS