Provider Demographics
NPI:1184726606
Name:ROBERT E. FRAZIER MD PC
Entity type:Organization
Organization Name:ROBERT E. FRAZIER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-443-1508
Mailing Address - Street 1:201 W BROADWAY
Mailing Address - Street 2:SUITE 2-D
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-3842
Mailing Address - Country:US
Mailing Address - Phone:573-443-1508
Mailing Address - Fax:573-443-1508
Practice Address - Street 1:201 W BROADWAY
Practice Address - Street 2:SUITE 2-D
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3842
Practice Address - Country:US
Practice Address - Phone:573-443-1508
Practice Address - Fax:573-443-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO333612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA11960Medicare UPIN
MO9605Medicare ID - Type Unspecified# OF ROBERT E. FRAZIER MD