Healthcare Provider Details

I. General information

NPI: 1801887476
Provider Name (Legal Business Name): DAVID B FRASER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19942 SAINT JOSEPH DR CENTERVILLE MEDICAL CLINIC
CENTERVILLE IA
52544-8849
US

IV. Provider business mailing address

19876 SAINT JOSEPH DR CENTERVILLE MEDICAL CLINIC
CENTERVILLE IA
52544-8850
US

V. Phone/Fax

Practice location:
  • Phone: 641-856-8684
  • Fax: 641-856-3009
Mailing address:
  • Phone: 641-856-8684
  • Fax: 641-856-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24957
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: