Provider Demographics
NPI:1932187663
Name:FRASER, SUSAN L (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:FRASER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1624 S I ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5016
Mailing Address - Country:US
Mailing Address - Phone:253-627-4123
Mailing Address - Fax:253-627-0714
Practice Address - Street 1:1624 S I ST
Practice Address - Street 2:SUITE 305
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5016
Practice Address - Country:US
Practice Address - Phone:253-428-8700
Practice Address - Fax:253-383-3376
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO28553207RI0200X
WAMD60539033207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2049768Medicaid