1174868392 NPI number — VESTIGE PROJECT

Table of content: DR. DANIEL BRUCE FRAM M.D. (NPI 1770586471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174868392 NPI number — VESTIGE PROJECT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VESTIGE PROJECT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1174868392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 E PLUMB LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89502-3536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-825-3043
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 E PLUMB LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-3536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-825-3043
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VANCIL
Authorized Official First Name:
JERAME
Authorized Official Middle Name:
TROY
Authorized Official Title or Position:
PSR
Authorized Official Telephone Number:
510-967-5298

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  0804464530 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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