Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 04-35812 | KS |
N | 208600000X | Surgeon | 04-35812 | KS |
N | 208200000X | Surgeon | 2012010191 | MO |
N | 208600000X | Surgeon | 2012010191 | MO |
N | 2086S0120X | Pediatric Surgery | 04-35812 | KS |
Y | 2086S0120X | Pediatric Surgery | 2012010191 | MO |
N | 2086S0120X | Pediatric Surgery | 37372 | AZ |
NPI | 1083643159 |
---|---|
Provider Name | Dr. Jason D Fraser |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 15/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
912035 | (05) | AZ |