Healthcare Provider Details

I. General information

NPI: 1710112123
Provider Name (Legal Business Name): MR. DANIEL FRASER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 LONE OAK RD STE. 230
PADUCAH KY
42003-7913
US

IV. Provider business mailing address

1532 LONE OAK RD STE. 345
PADUCAH KY
42003-7913
US

V. Phone/Fax

Practice location:
  • Phone: 270-538-5800
  • Fax: 270-538-5801
Mailing address:
  • Phone: 270-538-5800
  • Fax: 270-538-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: