Individual
DR. LARRY LYNN FRASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1300 N 4TH ST, LONGVIEW, TX 75601-4717
(903) 757-2122
(903) 757-9475
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 437-9605
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
G5058
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135968901
—
TX
05
—
135968903
—
TX
01
—
135968906
CSHCN
TX
05
—
135968908
—
TX
05
—
135968909
—
TX
05
—
135968910
—
TX
01
—
8R1439
BLUE CROSS OF TEXAS
TX
Enumeration date
06/12/2006
Last updated
05/02/2008
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