Provider Demographics
NPI:1548339070
Name:FRAZINE, RYAN CURTIS (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:CURTIS
Last Name:FRAZINE
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 1:2005 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7107
Mailing Address - Country:US
Mailing Address - Phone:270-366-7650
Mailing Address - Fax:270-443-0660
Practice Address - Street 1:2005 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7107
Practice Address - Country:US
Practice Address - Phone:270-366-7650
Practice Address - Fax:270-443-0660
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64098684Medicaid
KY64098684Medicaid
0257923Medicare ID - Type Unspecified