Provider Demographics
NPI:1912068131
Name:FRAYSER, SHELLY FRANCES (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:FRANCES
Last Name:FRAYSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHELLY
Other - Middle Name:FRANCES
Other - Last Name:BEHLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-476-5777
Mailing Address - Fax:208-476-5385
Practice Address - Street 1:301 CEDAR ST
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9029
Practice Address - Country:US
Practice Address - Phone:208-476-5777
Practice Address - Fax:208-476-5385
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-11296207P00000X, 207P00000X
TXN8785207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine