Provider Demographics
NPI:1902943764
Name:FLEISCHHAUER, THOMAS FRAZEE (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:FRAZEE
Last Name:FLEISCHHAUER
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 1:303 MEDICAL CENTER DR
Mailing Address - Street 2:TRI-LAKES MEDICAL CENTER
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-8608
Mailing Address - Country:US
Mailing Address - Phone:662-563-5611
Mailing Address - Fax:662-563-0155
Practice Address - Street 1:303 MEDICAL CENTER DR
Practice Address - Street 2:TRI-LAKES MEDICAL CENTER
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-8608
Practice Address - Country:US
Practice Address - Phone:662-563-5611
Practice Address - Fax:662-563-0155
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33653207Q00000X
MS19602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20450OtherCIGNA
NC680029OtherFIRST HEALTH
NCBCBSOtherINDIV.
MS07258508Medicaid
NC2118842OtherMAMSI
NC70036OtherPARTNERS
NC8932589Medicaid
NCC6798OtherMEDCOST
MSC03774Medicare PIN
NCC6798OtherMEDCOST
NC2118842OtherMAMSI
MSC01050Medicare PIN
MSC03436Medicare PIN