Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 0101-237302 | VA |
NPI | 1013987270 |
---|---|
Provider Name | Dr. John C Fraser |
First Address | Roanoke, VA 24016 |
Second Address | Roanoke, VA 24016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 11/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010117631 | (05) | VA |
010408890 | (05) | VA |
010413117 | (05) | VA |
010413273 | (05) | VA |
D02476 | (02) | VA |