Provider Demographics
NPI:1114254182
Name:FRAZEE, LARI L (DO)
Entity Type:Individual
Prefix:
First Name:LARI
Middle Name:L
Last Name:FRAZEE
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 1:6512 S MCCARRAN BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6141
Mailing Address - Country:US
Mailing Address - Phone:775-900-9987
Mailing Address - Fax:775-900-9954
Practice Address - Street 1:6512 S MCCARRAN BLVD STE D
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6141
Practice Address - Country:US
Practice Address - Phone:775-900-9987
Practice Address - Fax:775-900-9954
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10977208000000X
NV1746208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1114254182Medicaid