Healthcare Provider Details

I. General information

NPI: 1740418284
Provider Name (Legal Business Name): KEVIN GARY FRAZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 09/14/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S CHURCH ST
FAYETTE MO
65248-1243
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 660-248-2217
  • Fax: 660-248-3450
Mailing address:
  • Phone: 573-882-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2012008857
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: