Provider Demographics
NPI:1780783779
Name:FRAZIER, MOJISOLA
Entity type:Individual
Prefix:MS
First Name:MOJISOLA
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 E ABRAM ST STE N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-7253
Mailing Address - Country:US
Mailing Address - Phone:817-716-8814
Mailing Address - Fax:817-303-3720
Practice Address - Street 1:1411 E ABRAM ST STE N
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-7253
Practice Address - Country:US
Practice Address - Phone:817-716-8814
Practice Address - Fax:817-303-3720
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No251E00000XAgenciesHome Health
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1425738-01Medicaid
TX1425738-01Medicaid