Provider Demographics
NPI:1659592509
Name:FRAZER, JASON ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALLEN
Last Name:FRAZER
Suffix:
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 1:3200 MACCORKLE AVENUE
Mailing Address - Street 2:HOSPITALIST PROGRAM
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-388-5848
Mailing Address - Fax:304-388-9654
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:SUITE B16
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-5848
Practice Address - Fax:304-388-9654
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23048207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2030571Medicare PIN
2030574Medicare PIN
2030577Medicare PIN
2030572Medicare PIN
WVWV1104BMedicare PIN
2030576Medicare PIN
2030573Medicare PIN
2030575Medicare PIN
WVWV1104AMedicare PIN
WV4237201Medicare PIN
WV3810012398Medicaid