Provider Demographics
NPI:1578657334
Name:FRAZIER, TIMOTHY C
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1111
Mailing Address - Country:US
Mailing Address - Phone:865-525-2640
Mailing Address - Fax:865-525-9536
Practice Address - Street 1:2121 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1111
Practice Address - Country:US
Practice Address - Phone:865-525-2640
Practice Address - Fax:865-525-9536
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4080207KA0200X
TN231750208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3085235Medicaid
TN3028772OtherBCBS OF TN
TN3028772OtherBCBS OF TN
E39171Medicare UPIN