Healthcare Provider Details

I. General information

NPI: 1013542380
Provider Name (Legal Business Name): SEAN FRASER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2020
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 PAN AMERICAN FWY NE
ALBUQUERQUE NM
87107-6833
US

IV. Provider business mailing address

4333 PAN AMERICAN FWY NE
ALBUQUERQUE NM
87107-6833
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-3835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2025-1075
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: