Provider Demographics
NPI:1184627432
Name:FRAZZETTA, GAYLE (MD)
Entity type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:
Last Name:FRAZZETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4234
Mailing Address - Country:US
Mailing Address - Phone:970-252-9644
Mailing Address - Fax:970-252-9646
Practice Address - Street 1:224 S NEVADA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4234
Practice Address - Country:US
Practice Address - Phone:970-252-9644
Practice Address - Fax:970-252-9646
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01327303Medicaid
CO01327303Medicaid
COF64533Medicare UPIN