Healthcare Provider Details

I. General information

NPI: 1235481748
Provider Name (Legal Business Name): BENJAMIN J FRAZIER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 MOCKSVILLE AVE
SALISBURY NC
28144-2705
US

IV. Provider business mailing address

611 MOCKSVILLE AVE
SALISBURY NC
28144-2705
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-7220
  • Fax: 704-633-7074
Mailing address:
  • Phone: 704-633-7220
  • Fax: 704-633-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number222246
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: