Provider Demographics
NPI:1528068814
Name:CANTRELL, FRANK L (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:L
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6057 N 1ST ST
Mailing Address - Street 2:#101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5468
Mailing Address - Country:US
Mailing Address - Phone:559-435-0600
Mailing Address - Fax:559-435-2124
Practice Address - Street 1:6057 N 1ST ST
Practice Address - Street 2:#101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5468
Practice Address - Country:US
Practice Address - Phone:559-435-0600
Practice Address - Fax:559-435-2124
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA233142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A233140Medicare ID - Type Unspecified