Healthcare Provider Details

I. General information

NPI: 1811185887
Provider Name (Legal Business Name): FRASER MACFARLANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9978 N 5680 W
HIGHLAND UT
84003-3476
US

IV. Provider business mailing address

9978 N 5680 W
HIGHLAND UT
84003-3476
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-3446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5142893-4406
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55622
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number5142893-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: