Provider Demographics
NPI:1487710042
Name:FRAILIE, CHRISTOPHER JEROME (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JEROME
Last Name:FRAILIE
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:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36536-1080
Mailing Address - Country:US
Mailing Address - Phone:251-970-1646
Mailing Address - Fax:251-970-1648
Practice Address - Street 1:1613 N MCKENZIE STREET
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-949-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00024424207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009912238Medicaid
AL009912306Medicaid
AL009912303Medicaid
AL510-07041OtherBCBS
AL009912304Medicaid
AL510-07037OtherBCBS
AL510-07038OtherBCBS
AL009994755Medicaid
AL1487710042OtherTRICARE SOUTH
AL510-07039OtherBCBS
AL009994755Medicaid
AL510-07041OtherBCBS
AL051528193Medicare ID - Type Unspecified
AL009912238Medicaid