Provider Demographics
NPI:1215106729
Name:FRAZIER KING
Entity type:Organization
Organization Name:FRAZIER KING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRAZIER
Authorized Official - Middle Name:HERMON
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-255-1523
Mailing Address - Street 1:2023 SANDPOINT WEST DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-255-1523
Mailing Address - Fax:208-255-7894
Practice Address - Street 1:2023 SANDPOINT WEST DRIVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-255-1523
Practice Address - Fax:208-255-7894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8G098OtherBLUE CROSS OF IDAHO
ID8G098OtherBLUE CROSS OF IDAHO
IDX82597Medicare UPIN