Provider Demographics
NPI:1366423105
Name:FRAZIER, CHRISTOPHER P (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:326 N SAWYER RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2573
Practice Address - Country:US
Practice Address - Phone:260-349-9166
Practice Address - Fax:260-349-9175
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056639A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000667061OtherANTHEM
000000324242OtherBLUE CROSS BLUE SHIELD
15664OtherPHYSICIANS HEALTH PLAN
INP00135454OtherRAILROAD MEDICARE
000000027090OtherMPLAN
IN200390420Medicaid
INP00895097OtherMEDICARE RR
000000324242OtherBLUE CROSS BLUE SHIELD
15664OtherPHYSICIANS HEALTH PLAN
IN000000667061OtherANTHEM
IN551730DMedicare PIN