Provider Demographics
NPI:1194824672
Name:FRAZER, MARK EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EUGENE
Last Name:FRAZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1010 SUMMITT DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3400
Mailing Address - Country:US
Mailing Address - Phone:513-424-0122
Mailing Address - Fax:513-424-3863
Practice Address - Street 1:1010 SUMMIT DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042
Practice Address - Country:US
Practice Address - Phone:513-424-0122
Practice Address - Fax:513-424-3863
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-049126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0528816Medicaid
OHFR0568422Medicare ID - Type Unspecified
OH0528816Medicaid