Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 2018028949 | MO |
NPI | 1700366218 |
---|---|
Provider Name | Mrs. Regina Marie Frazier |
First Address | Jackson, MO 63755-1658 |
Second Address | Cape Girardeau, MO 63703-4928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 15/08/2018 |