Provider Demographics
NPI:1174719413
Name:CLONTZ, FRANKLIN D II (MD)
Entity type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:D
Last Name:CLONTZ
Suffix:II
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 1:200 N MANGOUSTINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1017
Mailing Address - Country:US
Mailing Address - Phone:407-322-7841
Mailing Address - Fax:407-833-7509
Practice Address - Street 1:200 N MANGOUSTINE AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1017
Practice Address - Country:US
Practice Address - Phone:407-322-7841
Practice Address - Fax:407-833-7509
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0011095208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045563600Medicaid
FL045563600Medicaid