Basic Information
| Provider Information | |||||||||
| NPI: | 1962902825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRANKO | ||||||||
| FirstName: | JACE | ||||||||
| MiddleName: | JOHN PHILIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9040 FITZSIMMONS DR | ||||||||
| Address2: | |||||||||
| City: | JOINT BASE LEWIS MCCHORD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984311000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539680236 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9040 FITZSIMMONS DR | ||||||||
| Address2: | |||||||||
| City: | JOINT BASE LEWIS MCCHORD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539680236 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2018 | ||||||||
| LastUpdateDate: | 09/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 60887085 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | 31969 | NE | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.