Provider Demographics
NPI:1780244095
Name:FRAZER, DAVID B
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:FRAZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3257 N SHEFFIELD AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2276
Mailing Address - Country:US
Mailing Address - Phone:773-236-8566
Mailing Address - Fax:
Practice Address - Street 1:3257 N SHEFFIELD AVE STE 118
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2276
Practice Address - Country:US
Practice Address - Phone:773-236-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist