MEDICARE: COSMO L FRASER, MD

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
1	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1285407536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSMO L FRASER, MD

Provider Business Mailing Address
First Line	:	220 STANDIFORD AVE STE F
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95350-1159
Country	:	US
Telephone Number	:	209-579-5628
Fax Number	:	209-579-5637

Provider Business Practice Location Address
First Line	:	2115 E ONSTOTT RD
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-1587
Country	:	US
Telephone Number	:	530-751-0339
Fax Number	:	530-751-0449

Authorized Official
Title or Position	:	MD/OWNER
Name	:	DR. COSMO FRASER
Credential	:	MD
Telephone Number	:	530-218-5536

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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