MEDICARE: DR. WENDY DEVONNE FRAZIER M.D.

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	207Q00000X	Family Medicine Physician	27718	NE
2	207Q00000X	Family Medicine Physician	036149571	IL
3	207Q00000X	Family Medicine Physician	2021044775	MO

General Provider Information

NPI Number	:	1629332127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDY DEVONNE FRAZIER M.D.

Provider Business Mailing Address
First Line	:	660 MASON RIDGE CENTER DR STE 300
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8512
Country	:	US
Telephone Number	:	314-448-3791
Fax Number	:	636-996-7658

Provider Business Practice Location Address
First Line	:	3433 N HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-1647
Country	:	US
Telephone Number	:	314-720-4380
Fax Number	:	636-996-7658

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

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	07/25/2024

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Directions to “ DR. WENDY DEVONNE FRAZIER M.D.” Practice Location

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