Provider Demographics
NPI:1174090443
Name:FRAZIER, DAVID L JR
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:FRAZIER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 E 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3134 E 79TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5738
Practice Address - Country:US
Practice Address - Phone:219-945-1754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3133237700000X
261QH0700X, 261QR0400X, 261QR1100X, 332S00000X
IN17001459A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No332S00000XSuppliersHearing Aid Equipment