Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 104 | WY |
N | 222Z00000X | Podiatrist | 104 | WY |
N | 213EP1101X | Primary Podiatric Medicine | 104 | WY |
N | 111NR0200X | Radiology | 104 | WY |
N | 213ER0200X | Radiology | 104 | WY |
N | 2081S0010X | Sports Medicine | 104 | WY |
N | 213ES0000X | Sports Medicine | 104 | WY |
Y | 213ES0103X | Foot & Ankle Surgery | 104 | WY |
N | 213ES0131X | Foot Surgery | 104 | WY |
NPI | 1114923463 |
---|---|
Provider Name | Dr. Duncan Hugh Fraser |
First Address | Powell, WY 82435-2260 |
Second Address | Powell, WY 82435-2260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 28/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0211460001 | DMERC # (01) | WI |
307844 | BLUE CROSS PROVIDER # (01) | WY |
T67619 | (02) | WY |