Individual
LARITA L FRAZIER O'BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4623 WESLEY AVE, STE P, CINCINNATI, OH 45212-2246
(513) 841-0777
(513) 841-0877
Mailing address
155 TRI COUNTY PKWY, STE 240, CINCINNATI, OH 45246-3238
(513) 771-9888
(513) 771-3686
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35.063095
OH
207QA0505X
Adult Medicine Physician
35-063095
OH
207QG0300X
Geriatric Medicine (Family Medicine) Physician
35-063095
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0904703
—
OH
Enumeration date
07/04/2006
Last updated
05/20/2013
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