Provider Demographics
NPI:1861939282
Name:BRENT FRAZEE, MD, LLC
Entity type:Organization
Organization Name:BRENT FRAZEE, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FRAZEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-635-9382
Mailing Address - Street 1:325 NW 21ST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1179
Mailing Address - Country:US
Mailing Address - Phone:503-886-8588
Mailing Address - Fax:503-200-1011
Practice Address - Street 1:325 NW 21ST AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1179
Practice Address - Country:US
Practice Address - Phone:503-886-8588
Practice Address - Fax:503-200-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1797722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty