MEDICARE: FRASER PROFESSIONAL MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207QS0010X	Sports Medicine (Family Medicine) Physician
2	2084P0800X	Psychiatry Physician
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1194313346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRASER PROFESSIONAL MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	77 3RD ST
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-8179
Country	:	US
Telephone Number	:	719-633-5255
Fax Number	:	719-488-6753

Provider Business Practice Location Address
First Line	:	77 3RD ST
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-8179
Country	:	US
Telephone Number	:	719-633-5255
Fax Number	:	719-488-6753

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. AARON SOOTS FRASER
Credential	:	D.O.L
Telephone Number	:	719-633-5255

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	02/05/2024

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Directions to “FRASER PROFESSIONAL MEDICAL GROUP LLC ” Practice Location

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