Basic Information
| Provider Information | |||||||||
| NPI: | 1962454520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | FRAZIER | ||||||||
| MiddleName: | KAVANUAGH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 N 20TH ST | ||||||||
| Address2: | P.O. BOX 2125 | ||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347498303 | ||||||||
| FaxNumber: | 3347455243 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 N 20TH ST | ||||||||
| Address2: | #18 | ||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347498303 | ||||||||
| FaxNumber: | 3347455243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 02/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 00016727 | AL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 51077709 | 01 | AL | BLUE CROSS & BLUE SHIELD | OTHER | 000098560 | 05 | AL | MEDICAID | 000077708 | 05 | AL | MEDICAID | 000077709 | 05 | AL | MEDICAID | 51077708 | 01 | AL | BLUE CROSS & BLUE SHIELD | OTHER |