MEDICARE: DR. JEROME FRAZIER D.O.

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	207V00000X	Obstetrics & Gynecology Physician	0000	OK
2	207V00000X	Obstetrics & Gynecology Physician	A-1560-10	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1534731	OTHER	CA	MEDICAL UPIN

General Provider Information

NPI Number	:	1508066457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME FRAZIER D.O.

Provider Business Mailing Address
First Line	:	PO BOX 2397
Second Line	:
City	:	MESILLA PARK
State	:	NM
Zip	:	88047-2397
Country	:	US
Telephone Number	:	575-522-2800
Fax Number	:	575-522-7044

Provider Business Practice Location Address
First Line	:	1401 S DON ROSER DR
Second Line	:	SUITE D
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4567
Country	:	US
Telephone Number	:	575-522-2800
Fax Number	:	575-647-8381

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

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	08/19/2011

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Directions to “ DR. JEROME FRAZIER D.O.” Practice Location

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