Provider Demographics
NPI:1902999808
Name:FRAZIER, ROGER L (DO)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:L
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:2008 NO WALNUT ST
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348
Mailing Address - Country:US
Mailing Address - Phone:765-348-0902
Mailing Address - Fax:765-348-7276
Practice Address - Street 1:2008 NO WALNUT ST
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348
Practice Address - Country:US
Practice Address - Phone:765-348-0902
Practice Address - Fax:765-348-7276
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000218B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C24344Medicare UPIN
079010Medicare ID - Type Unspecified