Healthcare Provider Details

I. General information

NPI: 1720457351
Provider Name (Legal Business Name): RYAN FRAZER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3326 N 3RD AVE STE 201
PHOENIX AZ
85013-4336
US

IV. Provider business mailing address

1532 W FLOWER CIR S
PHOENIX AZ
85015-5840
US

V. Phone/Fax

Practice location:
  • Phone: 602-625-7944
  • Fax:
Mailing address:
  • Phone: 720-951-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7003
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number7003
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number7003
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: