MEDICARE: DR. STACEY ANNE FRAZIER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G84001	CA

General Provider Information

NPI Number	:	1528051505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY ANNE FRAZIER MD

Provider Business Mailing Address
First Line	:	18511 HIGHLANDER MEDICS ST
Second Line	:
City	:	FORT BLISS
State	:	TX
Zip	:	79906-5327
Country	:	US
Telephone Number	:	159-569-1620
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 ARNOLD ST
Second Line	:
City	:	TINKER AFB
State	:	OK
Zip	:	73145-8105
Country	:	US
Telephone Number	:	405-736-2487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	11/03/2023

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