Provider Demographics
NPI:1013019538
Name:FRAZIER, ROBERT EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:FRAZIER
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 1:367 CROWN PT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2202
Mailing Address - Country:US
Mailing Address - Phone:573-442-4346
Mailing Address - Fax:573-443-2027
Practice Address - Street 1:367 CROWN PT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2202
Practice Address - Country:US
Practice Address - Phone:573-442-4346
Practice Address - Fax:573-443-2027
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO333612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9605Medicare ID - Type Unspecified
MOA11960Medicare UPIN