Provider Demographics
NPI:1225396591
Name:FRAZIER, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14501 MAGNOLIA ST STE 104
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-1307
Mailing Address - Country:US
Mailing Address - Phone:714-908-4524
Mailing Address - Fax:657-227-8108
Practice Address - Street 1:14501 MAGNOLIA ST STE 104
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-1307
Practice Address - Country:US
Practice Address - Phone:714-908-4524
Practice Address - Fax:657-227-8108
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1273812084B0040X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program