Healthcare Provider Details

I. General information

NPI: 1053450080
Provider Name (Legal Business Name): BONNIE JEAN FRASER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9017 S PECOS RD STE 4575
HENDERSON NV
89074-7203
US

IV. Provider business mailing address

PO BOX 401357
LAS VEGAS NV
89140
US

V. Phone/Fax

Practice location:
  • Phone: 702-576-5880
  • Fax: 702-750-1414
Mailing address:
  • Phone: 702-576-5880
  • Fax: 702-750-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberNV12294
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: