Healthcare Provider Details

I. General information

NPI: 1497888358
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF BOWLING GREEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 ASHLEY CIR
BOWLING GREEN KY
42104-3383
US

IV. Provider business mailing address

1211 ASHLEY CIR
BOWLING GREEN KY
42104-3383
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-8700
  • Fax: 270-782-8704
Mailing address:
  • Phone: 270-782-8700
  • Fax: 270-782-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. ZAHID G. FRASER
Title or Position: PHYSICIAN PARTNER
Credential: M.D.
Phone: 270-782-8700