Individual
JEFFREY LEE FRAKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0449
Mailing address
4613 SHADOW WOOD CV, OWENSBORO, KY 42303-4490
(270) 685-6861
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036136948
IL
207L00000X
Anesthesiology Physician
34605
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MEDICARE GROUP PTAN
IL
05
—
64042062
—
KY
Enumeration date
08/15/2005
Last updated
06/04/2021
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