Provider Demographics
NPI: | 1184094898 |
---|---|
Name: | CLAUDE C. FRAZIER, III, DO |
Entity type: | Organization |
Organization Name: | CLAUDE C. FRAZIER, III, DO |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CLAUDE |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | FRAZIER |
Authorized Official - Suffix: | III |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 865-541-2929 |
Mailing Address - Street 1: | PO BOX 11849 |
Mailing Address - Street 2: | |
Mailing Address - City: | KNOXVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37939-1849 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 865-541-2929 |
Mailing Address - Fax: | 865-541-2928 |
Practice Address - Street 1: | 501 19TH ST |
Practice Address - Street 2: | STE 309 |
Practice Address - City: | KNOXVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37916-1854 |
Practice Address - Country: | US |
Practice Address - Phone: | 865-541-2929 |
Practice Address - Fax: | 865-541-2928 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-10-07 |
Last Update Date: | 2015-11-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 207N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Single Specialty |