Provider Demographics
NPI:1407851009
Name:FRAZIER, C RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:C
Middle Name:RICHARD
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 1:150 RIVER NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-1803
Mailing Address - Country:US
Mailing Address - Phone:254-968-6051
Mailing Address - Fax:254-968-4204
Practice Address - Street 1:150 RIVER NORTH BLVD
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1803
Practice Address - Country:US
Practice Address - Phone:254-968-6051
Practice Address - Fax:254-968-4204
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2381208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX90489401OtherUNITED HEALTHCARE PROV NO
TX103835801Medicaid
TX113010100OtherFIRST CARE PROVIDER NO
TX7040835001OtherCIGNA PROVIDER NUMBER
TX4458928OtherAETNA PROVIDER NUMBER
TX83J054OtherBCBS PROVIDER NUMBER
TX020024418OtherRAILROAD MEDICARE
TX4458928OtherAETNA PROVIDER NUMBER
TXE89801Medicare UPIN