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General NPI Number Information
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NPI Number | 1851861348
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Entity Type | Organization
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Legal Business Name | MEDICAL INJURY CARE PROVIDER NETWORK
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 1805 W COLONIAL DR STE A
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City | ORLANDO
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State | FL
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Zip | 32804-7011
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Country | US
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Telephone | 407-578-9142
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 W COLONIAL DR STE A
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City | ORLANDO
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State | FL
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Zip | 32804-7011
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Country | US
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Telephone | 407-578-9142
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OWEN D FRASER
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Credential | MD
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Telephone | 407-351-1095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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