Provider Demographics
NPI:1649344573
Name:DIVINCENZO, FRANK ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ANTHONY
Last Name:DIVINCENZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5227 E HIGHWAY 163
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-9567
Mailing Address - Country:US
Mailing Address - Phone:573-268-3500
Mailing Address - Fax:
Practice Address - Street 1:2900 TRIMBLE RD STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7180
Practice Address - Country:US
Practice Address - Phone:573-818-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF85185Medicare UPIN