Healthcare Provider Details

I. General information

NPI: 1013987270
Provider Name (Legal Business Name): JOHN C FRASER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIVERSIDE CIRCLE
ROANOKE VA
24016
US

IV. Provider business mailing address

3 RIVERSIDE CIRCLE
ROANOKE VA
24016
US

V. Phone/Fax

Practice location:
  • Phone: 540-224-5170
  • Fax: 540-985-9612
Mailing address:
  • Phone: 540-224-5170
  • Fax: 540-985-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0101-237302
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: