Provider Demographics
NPI:1700981016
Name:FINE, FRANK EDWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:EDWARD
Last Name:FINE
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 1:803 COFFEE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4227
Mailing Address - Country:US
Mailing Address - Phone:209-569-0776
Mailing Address - Fax:209-569-0778
Practice Address - Street 1:803 COFFEE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4227
Practice Address - Country:US
Practice Address - Phone:209-569-0776
Practice Address - Fax:209-569-0778
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0066472208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0896337Medicaid
CA00A664720Medicare ID - Type Unspecified
H10596Medicare UPIN