1184126328 NPI number — MICHAEL J FRAZIER DPM PA

Table of content: (NPI 1184126328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184126328 NPI number — MICHAEL J FRAZIER DPM PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL J FRAZIER DPM PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE FRAZIER FOOT AND ANKLE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184126328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12609 LOUETTA RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CYPRESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77429-5136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-720-8267
Provider Business Mailing Address Fax Number:
949-404-6690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12609 LOUETTA RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77429-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-720-8267
Provider Business Practice Location Address Fax Number:
866-804-7013
Provider Enumeration Date:
03/04/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FRAZIER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
281-720-8267

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200048607435 . This is a "CIGNA-PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1881958940 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 346895101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".