Provider Demographics
NPI:1659410892
Name:FRAZEL HISTO-PATH LAB INC
Entity Type:Organization
Organization Name:FRAZEL HISTO-PATH LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:ART (CAN)
Authorized Official - Phone:954-474-1349
Mailing Address - Street 1:12500 S W 12 STREET
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-4420
Mailing Address - Country:US
Mailing Address - Phone:954-474-1349
Mailing Address - Fax:
Practice Address - Street 1:12500 S W 12 STREET
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-4420
Practice Address - Country:US
Practice Address - Phone:954-474-1349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D0285627246QH0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL8750Medicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER