Provider Demographics
NPI:1578556767
Name:FRASIER, PERCY L (MD)
Entity Type:Individual
Prefix:
First Name:PERCY
Middle Name:L
Last Name:FRASIER
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 1:1989 MIAMISBURG CENTERVILLE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3858
Mailing Address - Country:US
Mailing Address - Phone:937-401-6822
Mailing Address - Fax:937-401-6910
Practice Address - Street 1:1989 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3859
Practice Address - Country:US
Practice Address - Phone:937-401-6822
Practice Address - Fax:937-401-6935
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049472207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0528807Medicaid
OH0528807Medicaid
OH0537653Medicare PIN
OH7284571Medicare PIN
OHA80728Medicare UPIN