Provider Demographics
NPI:1548245707
Name:MUKAIDA, FRANK YUTAKA (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:YUTAKA
Last Name:MUKAIDA
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 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4582
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4582
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22690207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCD8723OtherRR MEDICARE GROUP NUMBER
OR160048824OtherRR MEDICARE PTAN NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR1407812365OtherNBMC GROUP NPI NUMBER
OR165459Medicaid
OR930635514OtherGROUP TAX ID NUMBER
ORCD8723OtherRR MEDICARE GROUP NUMBER
ORR107374Medicare PIN
ORH20195Medicare UPIN