Provider Demographics
NPI:1790891893
Name:FRAZIER, RODERICK N (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:N
Last Name:FRAZIER
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 1:1717 SAINT JAMES PL STE 305
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-3421
Mailing Address - Country:US
Mailing Address - Phone:832-730-1255
Mailing Address - Fax:832-730-1253
Practice Address - Street 1:1717 SAINT JAMES PL STE 305
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-3421
Practice Address - Country:US
Practice Address - Phone:832-730-1255
Practice Address - Fax:832-730-1253
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1396208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00626MMedicare ID - Type Unspecified
C15738Medicare UPIN