Healthcare Provider Details

I. General information

NPI: 1588284145
Provider Name (Legal Business Name): BRETT MICHAEL FRAZIER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER CAMP LEJEUNE 100 BREWSTER BOULEVARD
CAMP LEJEUNE NC
28547
US

IV. Provider business mailing address

213 SILVER CREEK LOOP
SNEADS FERRY NC
28460-9490
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-3138
  • Fax:
Mailing address:
  • Phone: 443-553-3298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102206818
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: