Provider Demographics
NPI:1881686731
Name:FRAZIER, MICHAEL JAMES (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33801 1ST WAY S
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4546
Mailing Address - Country:US
Mailing Address - Phone:253-838-8377
Mailing Address - Fax:253-838-9474
Practice Address - Street 1:33801 1ST WAY S
Practice Address - Street 2:SUITE 105
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4546
Practice Address - Country:US
Practice Address - Phone:253-838-8377
Practice Address - Fax:253-838-9474
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO 669213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1115757Medicaid
U77391Medicare UPIN
WAAB28638Medicare PIN
WA5604050001Medicare NSC