MEDICARE: DR. DUNCAN HUGH FRASER D.P.M.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	104	WY
2	213ER0200X	Radiology Podiatrist	104	WY
3	213ES0000X	Sports Medicine Podiatrist	104	WY
4	213E00000X	Podiatrist	104	WY
5	213ES0103X	Foot & Ankle Surgery Podiatrist	104	WY
6	213ES0131X	Foot Surgery Podiatrist	104	WY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0211460001	OTHER	WI	DMERC #
2	307844	OTHER	WY	BLUE CROSS PROVIDER #

NPI Number	:	1114923463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUNCAN HUGH FRASER D.P.M.

Provider Business Mailing Address
First Line	:	777 AVENUE H
Second Line	:
City	:	POWELL
State	:	WY
Zip	:	82435-2260
Country	:	US
Telephone Number	:	307-754-9191
Fax Number	:	307-754-1291

Provider Business Practice Location Address
First Line	:	777 AVENUE H
Second Line	:
City	:	POWELL
State	:	WY
Zip	:	82435-2260
Country	:	US
Telephone Number	:	307-754-9191
Fax Number	:	307-754-1291

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/28/2008

777 AVENUE H , PHARMACY DEPARTMENT
POWELL, WY
82435-2260

Practice Phone: 307-754-1279
Practice Fax: 307-754-7732