Provider Demographics
NPI:1215047030
Name:FRANKLIN, TAMA L (MD)
Entity type:Individual
Prefix:DR
First Name:TAMA
Middle Name:L
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-6850
Mailing Address - Fax:417-269-5830
Practice Address - Street 1:3850 S NATIONAL AVE
Practice Address - Street 2:#400
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5287
Practice Address - Country:US
Practice Address - Phone:417-269-6850
Practice Address - Fax:417-269-5830
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115538207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
114634OtherBLUE CROSS MO
MO209797802Medicaid
005012043Medicare PIN
P00377287Medicare PIN
963285133Medicare PIN
114634OtherBLUE CROSS MO
MO209797802Medicaid