Provider Demographics
NPI:1346232428
Name:KING, FRAZIER H (MD)
Entity type:Individual
Prefix:DR
First Name:FRAZIER
Middle Name:H
Last Name:KING
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 NORTH DIVISION AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-263-3091
Mailing Address - Fax:208-263-3147
Practice Address - Street 1:1218 NORTH DIVISION AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-263-3091
Practice Address - Fax:208-263-3147
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2025-03-28
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
IDM8165207Q00000X
IDM-8165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID080195176OtherRAIL ROAD MEDICARE
ID50641OtherBLUE CROSS OF IDAHO
ID806042600Medicaid
ID000010032447OtherREGENCE
ID50641OtherBLUE CROSS OF IDAHO
ID080195176OtherRAIL ROAD MEDICARE