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NPI Code Detail

MEDICARE: ROBERT W FRASIER III MDPC

MEDICARE: ROBERT W FRASIER III MDPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician74158NM

General Provider Information

NPI Number : 1174693782
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT W FRASIER III MDPC
Provider Business Mailing Address
First Line : PO BOX 2156
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-2156
Country : US
Telephone Number : 505-753-6771
Fax Number : 505-747-0312
Provider Business Practice Location Address
First Line : 612 N PASEO DE ONATE STE D
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-2963
Country : US
Telephone Number : 505-753-6771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 03/17/2018

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Directions to “ ROBERT W FRASIER III MDPC” Practice Location

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