MEDICARE: IVAN A. FRAS 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	2084N0400X	Neurology Physician	G76024	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649358136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN A. FRAS MD

Provider Business Mailing Address
First Line	:	PO BOX 17959
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-1912
Country	:	US
Telephone Number	:	213-977-2435
Fax Number	:	213-481-1509

Provider Business Practice Location Address
First Line	:	637 LUCAS AVE
Second Line	:	SUITE 402
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-1912
Country	:	US
Telephone Number	:	213-977-2435
Fax Number	:	213-481-1509

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/01/2011

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