Provider Demographics
NPI:1598578528
Name:FRASER PROFESSIONAL MEDICAL GROUP LLC
Entity type:Organization
Organization Name:FRASER PROFESSIONAL MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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:719-488-6753
Practice Address - Street 1:9475 BRIAR VILLAGE PT STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7902
Practice Address - Country:US
Practice Address - Phone:719-633-5255
Practice Address - Fax:719-488-6753
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRASER PROFESSIONAL MEDICAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care