Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 214813 | MA |
Y | 208600000X | Surgeon | 214813 | MA |
N | 2086S0127X | Trauma Surgeon | 214813 | MA |
NPI | 1306844212 |
---|---|
Provider Name | Denise M Fraser |
First Address | Oak Bluffs, MA 02557-1477 |
Second Address | Oak Bluffs, MA 02557-1477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 27/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0174530 | (05) | MA |
E70356 | (02) |