MEDICARE: MADISON FRASER

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer	7207	FL

General Provider Information

NPI Number	:	1982391173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON FRASER

Provider Business Mailing Address
First Line	:	4434 WINDERWOOD CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-2636
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4434 WINDERWOOD CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-2636
Country	:	US
Telephone Number	:	407-492-1045
Fax Number	:

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

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	07/16/2024

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Directions to “ MADISON FRASER ” Practice Location

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