MEDICARE: GARTH R FRAGA 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	2000153499	MO
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	0426780	KS

General Provider Information

NPI Number	:	1497745657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARTH R FRAGA MD

Provider Business Mailing Address
First Line	:	PO BOX 411851
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64141-1851
Country	:	US
Telephone Number	:	913-945-6787
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	4070 DELP MAIL STOP 4017
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-0001
Country	:	US
Telephone Number	:	913-945-6787
Fax Number	:

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/17/2014

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