Provider Demographics
NPI:1073131330
Name:FRAZIER, JOHN FRANCIS JR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANCIS
Last Name:FRAZIER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 DERBY LN
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-2147
Mailing Address - Country:US
Mailing Address - Phone:978-618-3532
Mailing Address - Fax:
Practice Address - Street 1:36 DERBY LN
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-2147
Practice Address - Country:US
Practice Address - Phone:978-618-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant