Healthcare Provider Details

I. General information

NPI: 1902269566
Provider Name (Legal Business Name): ANDREW FRAZIER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 WASHINGTON ST STE 1200
KANSAS CITY MO
64111-5905
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400S
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2932
  • Fax: 816-932-5491
Mailing address:
  • Phone: 816-932-5678
  • Fax: 816-932-7957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9408888
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2021013639
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: