1205966256 NPI number — DR. THOMAS HALL FRAZIER M.D.

Table of content: DR. THOMAS HALL FRAZIER M.D. (NPI 1205966256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205966256 NPI number — DR. THOMAS HALL FRAZIER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRAZIER
Provider First Name:
THOMAS
Provider Middle Name:
HALL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1205966256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISA
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41230-0030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-638-1154
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 PROFESSIONAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230-9644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-638-4656
Provider Business Practice Location Address Fax Number:
606-638-4658
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  R1271 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 41998 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2632711 . This is a "WV BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00948000 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0000007716883 . This is a "BCBS KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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