Provider Demographics
NPI:1790219186
Name:FRASER, JAMES ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ANTONIO
Last Name:FRASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR STE 508
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1952
Mailing Address - Country:US
Mailing Address - Phone:903-595-6680
Mailing Address - Fax:903-592-1934
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 508
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1952
Practice Address - Country:US
Practice Address - Phone:903-595-6680
Practice Address - Fax:903-592-1934
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA194300208600000X
TXW1415208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery