Provider Demographics
NPI:1659470318
Name:FRAZIER, JAMES C II (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:FRAZIER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-1641
Mailing Address - Country:US
Mailing Address - Phone:417-354-1150
Mailing Address - Fax:417-354-1160
Practice Address - Street 1:801 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1641
Practice Address - Country:US
Practice Address - Phone:417-354-1150
Practice Address - Fax:417-354-1160
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102289207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR83544OtherBLUE CROSS
MO1659470318Medicaid
MO200452001Medicaid
AR83544OtherBLUE CROSS
MO1659470318Medicaid
MO004050108Medicare ID - Type Unspecified