Healthcare Provider Details

I. General information

NPI: 1306207378
Provider Name (Legal Business Name): BONNIE J FRASER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8975 W CHARLESTON BLVD STE 130-24
LAS VEGAS NV
89117-5470
US

IV. Provider business mailing address

PO BOX 401357
LAS VEGAS NV
89140-1357
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 Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: BONNIE J FRASER
Title or Position: PRESIDENT
Credential: MD
Phone: 702-576-5880