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NPI Code Detail

MEDICARE: MALCOLM R FRASER MD

MEDICARE: MALCOLM R 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
1207QG0300XGeriatric Medicine (Family Medicine) PhysicianME36199FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2010065834OTHERFLRAILROAD MEDICARE
4010066083OTHERFLRAILROAD MEDICARE
5010066171OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
162242OTHERFLBC/BS FLA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861486177
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALCOLM R FRASER MD
Provider Business Mailing Address
First Line : 605 LAMAR AVE
Second Line :
City : BROOKSVILLE
State : FL
Zip : 34601-3211
Country : US
Telephone Number : 352-799-5411
Fax Number : 352-544-2713
Provider Business Practice Location Address
First Line : 605 LAMAR AVE
Second Line :
City : BROOKSVILLE
State : FL
Zip : 34601-3211
Country : US
Telephone Number : 352-799-5411
Fax Number : 352-544-2713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 09/22/2014

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Directions to “ MALCOLM R FRASER MD” Practice Location

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