Healthcare Provider Details

I. General information

NPI: 1194313346
Provider Name (Legal Business Name): FRASER PROFESSIONAL MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 3RD ST
MONUMENT CO
80132-8179
US

IV. Provider business mailing address

77 3RD ST
MONUMENT CO
80132-8179
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-5255
  • Fax: 719-488-6753
Mailing address:
  • Phone: 719-633-5255
  • Fax: 719-488-6753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON SOOTS FRASER
Title or Position: MEDICAL DIRECTOR
Credential: D.O.L
Phone: 719-633-5255