Provider Demographics
NPI:1164407854
Name:FRAZIER, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
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 1:6418 ROYALTON DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3513
Mailing Address - Country:US
Mailing Address - Phone:214-552-6660
Mailing Address - Fax:214-368-3446
Practice Address - Street 1:6418 ROYALTON DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3513
Practice Address - Country:US
Practice Address - Phone:214-552-6660
Practice Address - Fax:214-368-3446
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45667207P00000X
TXD5606207P00000X
MO2012003308207P00000X
IN01022165A207P00000X
NY107900207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046439808Medicaid
C15736Medicare UPIN
TX046439808Medicaid