Provider Demographics
NPI:1992794614
Name:FRASER, DAVID DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DONALD
Last Name:FRASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1126B KELLUM LOOP RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3304
Mailing Address - Country:US
Mailing Address - Phone:910-577-0177
Mailing Address - Fax:910-577-0183
Practice Address - Street 1:1126B KELLUM LOOP RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3304
Practice Address - Country:US
Practice Address - Phone:910-577-0177
Practice Address - Fax:910-577-0183
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31985207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8933694Medicaid
E67827Medicare UPIN
2344343AMedicare ID - Type Unspecified