Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 19621 | WV |
NPI | 1235237405 |
---|---|
Provider Name | Dr. Teresa Elizabeth Frazer |
First Address | Ronceverte, WV 24970-8016 |
Second Address | Bluefield, WV 24701-3338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 11/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010119294 | (05) | VA |
1808202000 | (05) | WV |
D26632 | (02) |