Provider Demographics
NPI:1417146267
Name:FRASER, WARREN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:MICHAEL
Last Name:FRASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 NORTH BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4013
Mailing Address - Country:US
Mailing Address - Phone:225-341-5901
Mailing Address - Fax:225-341-5903
Practice Address - Street 1:4550 NORTH BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4013
Practice Address - Country:US
Practice Address - Phone:225-341-5901
Practice Address - Fax:225-341-5903
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011684207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1140252Medicaid
LA1140252Medicaid