Provider Demographics
NPI:1902191125
Name:FRONTIER MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:FRONTIER MEDICAL GROUP INC.
Other - Org Name:FRONTIER MEDICAL GROUP INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-652-9283
Mailing Address - Street 1:1016 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1505
Mailing Address - Country:US
Mailing Address - Phone:310-652-9283
Mailing Address - Fax:310-652-9292
Practice Address - Street 1:1016 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1505
Practice Address - Country:US
Practice Address - Phone:310-652-9283
Practice Address - Fax:310-652-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100982213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty