Provider Demographics
NPI:1366426595
Name:FRANKLIN, JACK P (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:P
Last Name:FRANKLIN
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 1:906 FORD ST
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-2345
Mailing Address - Country:US
Mailing Address - Phone:325-248-6309
Mailing Address - Fax:325-248-6307
Practice Address - Street 1:906 FORD ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-2345
Practice Address - Country:US
Practice Address - Phone:325-248-6309
Practice Address - Fax:325-248-6307
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125243902Medicaid
TX125243904Medicaid
TX125243904Medicaid
TX83010KOtherBCBS
TX125243902Medicaid
TX125243902Medicaid
TX83010KMedicare PIN
TX99407OtherSCOTT & WHITE