Provider Demographics
NPI:1245228196
Name:FRAZIER, ELLIS (MD)
Entity Type:Individual
Prefix:
First Name:ELLIS
Middle Name:
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 1:100 INDIAN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9654
Mailing Address - Country:US
Mailing Address - Phone:740-289-1548
Mailing Address - Fax:740-289-3989
Practice Address - Street 1:100 INDIAN RIDGE DR
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9654
Practice Address - Country:US
Practice Address - Phone:740-289-1548
Practice Address - Fax:740-289-3989
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052676F207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0720769Medicaid
2534182OtherCIGNA
OH000000281343OtherUNISON
000000634422OtherANTHEM
000000634422OtherANTHEM
OH0720769Medicaid