MEDICARE: SARAH BETH MATOUSEK-FRASER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	26426	OK
2	207RP1001X	Pulmonary Disease Physician	26426	OK

General Provider Information

NPI Number	:	1083874267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH BETH MATOUSEK-FRASER MD

Provider Business Mailing Address
First Line	:	5300 N INDEPENDENCE AVE
Second Line	:	280
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5556
Country	:	US
Telephone Number	:	580-977-1864
Fax Number	:	580-977-1865

Provider Business Practice Location Address
First Line	:	620 S MADISON ST STE 209
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-7270
Country	:	US
Telephone Number	:	580-977-1864
Fax Number	:	580-977-1865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	05/07/2021

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