Provider Demographics
NPI:1467060343
Name:GEROPSYCHMD LLC
Entity Type:Organization
Organization Name:GEROPSYCHMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-930-2248
Mailing Address - Street 1:9618 N 35TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4934
Mailing Address - Country:US
Mailing Address - Phone:602-930-2248
Mailing Address - Fax:623-399-9958
Practice Address - Street 1:9618 N 35TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4934
Practice Address - Country:US
Practice Address - Phone:602-930-2248
Practice Address - Fax:623-399-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ28771Other28771