Healthcare Provider Details

I. General information

NPI: 1922918374
Provider Name (Legal Business Name): DOMINIC JOSEPH FRASER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S DOWNING ST
DENVER CO
80210-5817
US

IV. Provider business mailing address

1470 YATES ST
DENVER CO
80204-1031
US

V. Phone/Fax

Practice location:
  • Phone: 303-778-1955
  • Fax:
Mailing address:
  • Phone: 970-397-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN.1687929
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: