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General NPI Number Information
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NPI Number | 1861939282
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Entity Type | Organization
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Legal Business Name | BRENT FRAZEE, MD, LLC
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 10/15/2017
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Provider Practice Location Address
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Address Line | 325 NW 21ST AVE STE 100
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City | PORTLAND
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State | OR
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Zip | 97209-1179
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Country | US
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Telephone | 503-886-8588
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Fax | 503-200-1011
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Provider Business Mailing Address
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Address Line | 325 NW 21ST AVE STE 100
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City | PORTLAND
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State | OR
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Zip | 97209-1179
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Country | US
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Telephone | 503-886-8588
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Fax | 503-200-1011
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. BRENT WILLIAM FRAZEE
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Credential | M.D.
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Telephone | 512-635-9382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD179772
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License Number State | OR
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