Provider Demographics
NPI:1659329902
Name:FRAZIER, ROBERT ANTHONY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:FRAZIER
Suffix:JR
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:PO BOX 2453
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-2453
Mailing Address - Country:US
Mailing Address - Phone:757-664-7901
Mailing Address - Fax:
Practice Address - Street 1:733 BOUSH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1501
Practice Address - Country:US
Practice Address - Phone:757-664-7901
Practice Address - Fax:757-664-9122
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055418207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004991427Medicaid
VA190000599Medicare ID - Type Unspecified
VAD71853Medicare UPIN