Provider Demographics
NPI:1215790993
Name:FRASER PROFESSIONAL MEDICAL GROUP
Entity type:Organization
Organization Name:FRASER PROFESSIONAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:SOOTS
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-633-5255
Mailing Address - Street 1:1615 SILVERSMITH RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7225
Mailing Address - Country:US
Mailing Address - Phone:719-633-5255
Mailing Address - Fax:
Practice Address - Street 1:3525 AMERICAN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5743
Practice Address - Country:US
Practice Address - Phone:719-633-5255
Practice Address - Fax:719-488-6753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty