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General NPI Number Information
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NPI Number | 1588694541
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Entity Type | Individual
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Provider Name | LARITA L FRAZIER O'BANNON MD
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 4623 WESLEY AVE STE P
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City | CINCINNATI
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State | OH
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Zip | 45212-2246
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Country | US
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Telephone | 513-841-0777
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Fax | 513-841-0877
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Provider Business Mailing Address
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Address Line | 155 TRI COUNTY PKWY STE 240
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City | CINCINNATI
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State | OH
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Zip | 45246-3238
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Country | US
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Telephone | 513-771-9888
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Fax | 513-771-3686
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 35-063095
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 35-063095
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.063095
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License Number State | OH
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