Healthcare Provider Details

I. General information

NPI: 1982675583
Provider Name (Legal Business Name): LEWIS KEITH FRASER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 COX CREEK PKWY STE A
FLORENCE AL
35630-1105
US

IV. Provider business mailing address

646 COX CREEK PKWY STE A
FLORENCE AL
35630-1105
US

V. Phone/Fax

Practice location:
  • Phone: 256-760-1771
  • Fax: 256-760-9149
Mailing address:
  • Phone: 256-760-1771
  • Fax: 256-760-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number00006384
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: