Provider Demographics
NPI:1093799777
Name:FRAYER, CRAIG A (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:FRAYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 HOSPITAL LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1276
Mailing Address - Country:US
Mailing Address - Phone:573-547-4899
Mailing Address - Fax:573-547-5388
Practice Address - Street 1:206 HOSPITAL LN
Practice Address - Street 2:SUITE 201
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1276
Practice Address - Country:US
Practice Address - Phone:573-547-4899
Practice Address - Fax:573-547-5388
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2069207VX0000X
MO106717207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOI28231Medicare UPIN