Healthcare Provider Details

I. General information

NPI: 1760813950
Provider Name (Legal Business Name): ROBERT EUGENE FRASER RN-BC, CIC, CLNC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY MEDICAL DEPARTMENT ACTIVITY-JAPAN UNIT 45011
APO AP
96343-5011
US

IV. Provider business mailing address

PSC 704 BOX 3429
APO AP
96338-0015
US

V. Phone/Fax

Practice location:
  • Phone: 315-263-4546
  • Fax:
Mailing address:
  • Phone: 315-263-3691
  • Fax: 315-263-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number57389
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: