Provider Demographics
NPI:1922040682
Name:ROCKWALL FAMILY MEDICINE ASSOCIATES, PA
Entity Type:Organization
Organization Name:ROCKWALL FAMILY MEDICINE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-772-4644
Mailing Address - Street 1:2504 RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2569
Mailing Address - Country:US
Mailing Address - Phone:972-772-4644
Mailing Address - Fax:972-772-4654
Practice Address - Street 1:2504 RIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2569
Practice Address - Country:US
Practice Address - Phone:972-772-4644
Practice Address - Fax:972-772-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W260Medicare ID - Type UnspecifiedGROUP ID