1093710998 NPI number — FRANK J ARCHER MD

Table of content: FRANK J ARCHER MD (NPI 1093710998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093710998 NPI number — FRANK J ARCHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARCHER
Provider First Name:
FRANK
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093710998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPANISH FORK
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84660-0008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-798-5359
Provider Business Mailing Address Fax Number:
385-888-9171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 N 100 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPANISH FORK
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84660-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-465-4896
Provider Business Practice Location Address Fax Number:
801-465-3267
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4253A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 6701075-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114390500 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 308485 . This is a "BCBS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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