Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 106717 | MO |
N | 207VX0000X | Obstetrician | 2069 | TN |
NPI | 1093799777 |
---|---|
Provider Name | Dr. Craig A Frayer |
First Address | Perryville, MO 63775-1276 |
Second Address | Perryville, MO 63775-1276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 05/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I28231 | (02) | MO |