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General NPI Number Information
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NPI Number | 1194824672
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Entity Type | Individual
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Provider Name | MARK EUGENE FRAZER M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 1010 SUMMIT DRIVE
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City | MIDDLETOWN
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State | OH
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Zip | 45042
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Country | US
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Telephone | 513-424-0122
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Fax | 513-424-3863
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Provider Business Mailing Address
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Address Line | 1010 SUMMITT DR
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City | MIDDLETOWN
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State | OH
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Zip | 45042-3400
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Country | US
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Telephone | 513-424-0122
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Fax | 513-424-3863
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35-049126
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License Number State | OH
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