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General NPI Number Information
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NPI Number | 1861486177
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Entity Type | Individual
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Provider Name | MALCOLM R FRASER MD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2005
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 605 LAMAR AVE
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3211
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Country | US
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Telephone | 352-799-5411
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Fax | 352-544-2713
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Provider Business Mailing Address
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Address Line | 605 LAMAR AVE
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3211
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Country | US
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Telephone | 352-799-5411
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Fax | 352-544-2713
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | ME36199
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License Number State | FL
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