Provider Demographics
NPI:1952622656
Name:CLARK-THOMPSON, FRANK HASKIN III
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:HASKIN
Last Name:CLARK-THOMPSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BAKARI
Other - Middle Name:HASKIN
Other - Last Name:CLARK-THOMPSON
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1310 TULLY RD # SAN95112
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3054
Mailing Address - Country:US
Mailing Address - Phone:408-628-8654
Mailing Address - Fax:
Practice Address - Street 1:1310 TULLY RD # SAN95112
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3054
Practice Address - Country:US
Practice Address - Phone:408-628-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator