MEDICARE: JUSTIN FRAZIER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1114679289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN FRAZIER PA

Provider Business Mailing Address
First Line	:	2001 S SHIELDS ST STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1827
Country	:	US
Telephone Number	:	970-297-6600
Fax Number	:	970-297-6601

Provider Business Practice Location Address
First Line	:	2001 S SHIELDS ST STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1827
Country	:	US
Telephone Number	:	970-297-6600
Fax Number	:	970-297-6601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2022
Last Update Date	:	02/20/2026

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Directions to “ JUSTIN FRAZIER PA” Practice Location

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