Provider Demographics
NPI:1598879389
Name:FRAZIER, BRYANT J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:J
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 UNIVERSITY DR
Mailing Address - Street 2:STUDENT HEALTH CENTER
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4684
Mailing Address - Country:US
Mailing Address - Phone:512-245-2161
Mailing Address - Fax:512-245-9288
Practice Address - Street 1:601 UNIVERSITY DR
Practice Address - Street 2:STUDENT HEALTH CENTER
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4684
Practice Address - Country:US
Practice Address - Phone:512-245-2161
Practice Address - Fax:512-245-9288
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL0183207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1575136-01Medicaid
TX1575136-01Medicaid
TXG98872Medicare UPIN