Provider Demographics
NPI:1003138850
Name:FRAZIER, DAVID (SELF CONTRACTOR)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:SELF CONTRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471342
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80047-1342
Mailing Address - Country:US
Mailing Address - Phone:720-998-8415
Mailing Address - Fax:
Practice Address - Street 1:14701 E. TENNESSEE DR. # 1-123
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012
Practice Address - Country:US
Practice Address - Phone:720-998-8415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO$$$$$$$$$OtherSSN