Healthcare Provider Details

I. General information

NPI: 1669639092
Provider Name (Legal Business Name): DOUGLAS R FRASER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

PO BOX 888102
LOS ANGELES CA
90088-8102
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-1820
  • Fax: 562-933-1819
Mailing address:
  • Phone: 916-441-0400
  • Fax: 916-441-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number14823
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number14823
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: