1184126328 NPI number — MICHAEL FRAZIER DPM PLLC

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 FRAZIER DPM PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL FRAZIER DPM PLLC
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:
Provider Other Organization Name Type Code:
6
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:
08/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14926 TERRA POINT DR
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:
77429-4948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-702-6632
Provider Business Mailing Address Fax Number:
833-449-4091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21301 KUYKENDAHL RD STE J
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77379-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-702-6632
Provider Business Practice Location Address Fax Number:
833-449-4091
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:
713-702-6632

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: 386309401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 386309402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2127 . This is a "PODIATRY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 200048607435 . This is a "CIGNA-PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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