Provider Demographics
NPI:1851314033
Name:FRAZIER, RANDALL PARKS (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:PARKS
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 1:611 ALCORN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9302
Mailing Address - Country:US
Mailing Address - Phone:662-286-6369
Mailing Address - Fax:662-286-2768
Practice Address - Street 1:611 ALCORN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9302
Practice Address - Country:US
Practice Address - Phone:662-286-6369
Practice Address - Fax:662-286-2768
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12016207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00015139Medicaid
MS00015139Medicaid
MS200000157Medicare PIN