Provider Demographics
NPI:1205966256
Name:FRAZIER, THOMAS HALL (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HALL
Last Name:FRAZIER
Suffix:
Gender:M
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:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-0030
Mailing Address - Country:US
Mailing Address - Phone:606-638-1154
Mailing Address - Fax:
Practice Address - Street 1:32 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE 108
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9644
Practice Address - Country:US
Practice Address - Phone:606-638-4656
Practice Address - Fax:606-638-4658
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1271207R00000X
KY41998207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2632711OtherWV BCBS
KYP00948000OtherRR MEDICARE
KY0000007716883OtherBCBS KY
KYP00948000OtherRR MEDICARE