Healthcare Provider Details

I. General information

NPI: 1790792380
Provider Name (Legal Business Name): JEFFREY L FRASER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310C COUNTY ROAD 14
DEL NORTE CO
81132-8719
US

IV. Provider business mailing address

310 COUNTY ROAD 14
DEL NORTE CO
81132-8719
US

V. Phone/Fax

Practice location:
  • Phone: 719-657-2418
  • Fax: 719-657-3317
Mailing address:
  • Phone: 719-657-2510
  • Fax: 719-657-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0077960
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19664
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020-04208
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: