Provider Demographics
NPI:1942266606
Name:FRAZER, KEVIN GREGORY (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:GREGORY
Last Name:FRAZER
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 1:1300 MICCOSUKEE RD
Mailing Address - Street 2:BIXLER EMERGENCY CENTER
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5054
Mailing Address - Country:US
Mailing Address - Phone:850-431-0756
Mailing Address - Fax:850-431-0779
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:BIXLER EMERGENCY CENTER
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-0756
Practice Address - Fax:850-431-0779
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93591207P00000X
TXL9199207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273058800Medicaid
FL273058800Medicaid
FL16697ZMedicare ID - Type UnspecifiedMEDICARE NUMBER