Healthcare Provider Details

I. General information

NPI: 1528051505
Provider Name (Legal Business Name): STACEY ANNE FRAZIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 ARNOLD ST
TINKER AFB OK
73145-8105
US

IV. Provider business mailing address

18511 HIGHLANDER MEDICS ST
FORT BLISS TX
79906-5327
US

V. Phone/Fax

Practice location:
  • Phone: 405-736-2487
  • Fax:
Mailing address:
  • Phone: 159-569-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG84001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: