MEDICARE: DR. TOBIN J FRASER DO

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	207Q00000X	Family Medicine Physician	TF013087	MI
2	207Q00000X	Family Medicine Physician	5101013087	MI

General Provider Information

NPI Number	:	1336159102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOBIN J FRASER DO

Provider Business Mailing Address
First Line	:	4290 COPPER RIDGE DR STE 200
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7205
Country	:	US
Telephone Number	:	231-935-8930
Fax Number	:	231-935-8811

Provider Business Practice Location Address
First Line	:	4290 COPPER RIDGE DR STE 200
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7205
Country	:	US
Telephone Number	:	231-935-8930
Fax Number	:	231-935-8811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	08/23/2022

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Directions to “ DR. TOBIN J FRASER DO” Practice Location

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