Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 00695 | GA |
NPI | 1104868785 |
---|---|
Provider Name | Adam Michael Frasch |
First Address | Thomasville, GA 31792-6646 |
Second Address | Thomasville, GA 31792-6646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 22/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1092080001 | CIGNA GOVERNMENT SERVICES (01) | GA |
U45075 | (02) | GA |