Provider Demographics
NPI:1053450080
Name:FRASER, BONNIE JEAN (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:FRASER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 401357
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140
Mailing Address - Country:US
Mailing Address - Phone:702-576-5880
Mailing Address - Fax:702-750-1414
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:STE 550
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0490
Practice Address - Country:US
Practice Address - Phone:702-576-5880
Practice Address - Fax:702-750-1414
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV12294208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery