Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 77262 | GA |
NPI | 1003290511 |
---|---|
Provider Name | Dr. Daniel Jason Frasca |
First Address | Fort Gordon, GA 30905 |
Second Address | Fort Gordon, GA 30905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2015 |
Last Update Date | 05/09/2017 |