Provider Demographics
NPI:1982677928
Name:FRANK, PHILIP RANDALL (DO)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:RANDALL
Last Name:FRANK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 WILBUR RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-3626
Mailing Address - Country:US
Mailing Address - Phone:541-913-5971
Mailing Address - Fax:
Practice Address - Street 1:1602 WILBUR RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3626
Practice Address - Country:US
Practice Address - Phone:540-988-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO229572084P0800X
WAOP000023022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4763FROtherREGENCE
WA0256897OtherL&I AND CRIME VICTIMS
WA7113382OtherAETNA
WA8521452Medicaid
OR181443Medicaid
WA1982677928Medicaid
WAG8875445Medicare PIN
WA7113382OtherAETNA
WA8521452Medicaid
ORRR PTAN 260050463Medicare PIN
WA1982677928Medicaid