Provider Demographics
NPI:1881697712
Name:FRAZIER, ERIN RICHEY (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:RICHEY
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:RICHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-272-5395
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:230 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2026
Practice Address - Country:US
Practice Address - Phone:502-629-8990
Practice Address - Fax:502-394-3604
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37997208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000950945OtherANTHEM - NCMA
KY50094241OtherPASSPORT - NCMA
KY072195OtherSIHO
KY64055130Medicaid
KY072195OtherSIHO
KY64055130Medicaid