Healthcare Provider Details

I. General information

NPI: 1679756639
Provider Name (Legal Business Name): AMY J FRAZIER MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S 7TH AVE SUITE 200
PHOENIX AZ
85007-3913
US

IV. Provider business mailing address

PO BOX 32146
PHOENIX AZ
85064-2146
US

V. Phone/Fax

Practice location:
  • Phone: 623-236-2000
  • Fax:
Mailing address:
  • Phone: 623-236-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number28774
License Number StateAZ

VIII. Authorized Official

Name: DR. AMY J FRAZIER
Title or Position: CEO
Credential:
Phone: 623-236-2000