Basic Information
Provider Information
NPI: 1003138850
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRAZIER
FirstName: DAVID
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: SELF CONTRACTOR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 471342
Address2:  
City: AURORA
State: CO
PostalCode: 800471342
CountryCode: US
TelephoneNumber: 7209988415
FaxNumber:  
Practice Location
Address1: 14701 E. TENNESSEE DR. # 1-123
Address2:  
City: AURORA
State: CO
PostalCode: 80012
CountryCode: US
TelephoneNumber: 7209988415
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/22/2010
LastUpdateDate: 02/22/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171W00000X  Y Other Service ProvidersContractor 

No ID Information.


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