Provider Demographics
NPI:1952644023
Name:FRAZEE, BRENT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:WILLIAM
Last Name:FRAZEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 NW 21ST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1179
Mailing Address - Country:US
Mailing Address - Phone:503-886-8588
Mailing Address - Fax:503-200-1011
Practice Address - Street 1:325 NW 21ST AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1179
Practice Address - Country:US
Practice Address - Phone:503-886-8588
Practice Address - Fax:503-200-1011
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2017-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1797722084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry