Individual
FRANK J FAZZIO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7301 W EMERALD ST, STE 102, BOISE, ID 83704-8688
(208) 321-8600
(208) 321-8626
Mailing address
7301 W EMERALD ST, STE 102, BOISE, ID 83704-8688
(208) 321-8600
(208) 321-8626
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M3382
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020051465
RAILROAD MEDICARE
ID
01
—
1528035276
NPI
ID
01
—
204186533
TAX ID
ID
01
—
57851
BLUE CROSS
ID
Enumeration date
03/01/2006
Last updated
06/30/2010
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