MEDICARE: JEFFREY L 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	207Q00000X	Family Medicine Physician	19664	NE
2	207Q00000X	Family Medicine Physician	2020-04208	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03137	OTHER	NE	BCBS - LINC CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	500317	OTHER	NE	BCBS
4	01-00470	OTHER	NE	UHC
5	3850	OTHER	NE	MIDLAND'S CHOICE

General Provider Information

NPI Number	:	1790792380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY L FRASER MD

Provider Business Mailing Address
First Line	:	PO BOX 68
Second Line	:
City	:	POLLOCKSVILLE
State	:	NC
Zip	:	28573-0068
Country	:	US
Telephone Number	:	252-247-3257
Fax Number	:	252-247-1076

Provider Business Practice Location Address
First Line	:	4218 ARENDELL ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2866
Country	:	US
Telephone Number	:	252-247-3265
Fax Number	:	252-247-1076

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	11/25/2020

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