Healthcare Provider Details

I. General information

NPI: 1326485392
Provider Name (Legal Business Name): BEVON VERNET FRASER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N 11TH ST IM: INTERNAL MEDICINE CLINIC
RICHMOND VA
23298-5002
US

IV. Provider business mailing address

PO BOX 980509 IM: INTERNAL MEDICINE
RICHMOND VA
23298-0509
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-8786
  • Fax: 804-828-5466
Mailing address:
  • Phone: 804-828-9726
  • Fax: 804-828-4926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: