Provider Demographics
NPI:1982667473
Name:FRANK M DE MAYO M D P C
Entity Type:Organization
Organization Name:FRANK M DE MAYO M D P C
Other - Org Name:TRACY ORTHOPEDICS AND SPORTS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DE MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-835-4888
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:209-835-8888
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38277207X00000X
CAG60003207X00000X, 207XX0005X
CA26664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26664OtherANTHONY PHILLIPS - PT LIC
CA5673742OtherAETNA
CA90686OtherINTERPLAN
CAGR0087960Medicaid
CA00001OtherUNITED HEALTHCARE
CA032034OtherHILL PHYSICIANS
CAA53541Medicare UPIN
CA90686OtherINTERPLAN
CAGR0087960Medicaid