Healthcare Provider Details

I. General information

NPI: 1326107103
Provider Name (Legal Business Name): DOUGLAS JAMES FRASER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411A BACKLICK RD
SPRINGFIELD VA
22151-3915
US

IV. Provider business mailing address

5411A BACKLICK RD
SPRINGFIELD VA
22151-3915
US

V. Phone/Fax

Practice location:
  • Phone: 703-256-2474
  • Fax: 703-941-7938
Mailing address:
  • Phone: 703-256-2474
  • Fax: 703-941-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101023876
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: