Provider Demographics
NPI:1073550653
Name:FRAZIER, SHELLAINE R (DO)
Entity Type:Individual
Prefix:
First Name:SHELLAINE
Middle Name:R
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:DO
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 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:ONE HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-1311
Practice Address - Fax:573-884-4612
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002003277207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO127403OtherBLUE SHIELD/BLUE CHOICE
MO209086206Medicaid
MO1100845OtherUNITED HEALTHCARE
MO550185OtherHEALTHLINK
MO904285236Medicare PIN
MO1100845OtherUNITED HEALTHCARE
MOP00419278Medicare PIN
MO550185OtherHEALTHLINK
MOH95430Medicare UPIN
MO209086206Medicaid