Provider Demographics
NPI:1629036496
Name:FRAZIER, ALICE ANNE (DO)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ANNE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4150
Practice Address - Street 1:100 DAWN LN
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9138
Practice Address - Country:US
Practice Address - Phone:740-947-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005990F207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000552750OtherANTHEM/BCBS
OH0143197Medicaid
000000319938OtherBCBS
OH000000528249OtherANTHEM/BCBS
OHP00387464Medicare PIN
FR0798197Medicare PIN
000000319938OtherBCBS
OH000000552750OtherANTHEM/BCBS
OH0798199Medicare PIN
OH0798198Medicare PIN