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General NPI Number Information
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NPI Number | 1104906452
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Entity Type | Individual
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Provider Name | CHARLES D. FRASER JR. MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 4900 MUELLER BLVD
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City | AUSTIN
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State | TX
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Zip | 78723
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Country | US
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Telephone | 855-324-0091
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Fax | 512-380-7532
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Provider Business Mailing Address
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Address Line | 6621 FANNIN ST
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City | HOUSTON
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State | TX
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Zip | 77030-2303
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Country | US
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Telephone | 832-826-5731
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Fax | 832-825-1904
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | G8840
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | G8840
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License Number State | TX
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