Provider Demographics
NPI:1073092714
Name:FRASER, OBED (PA-C, MPAS)
Entity Type:Individual
Prefix:MR
First Name:OBED
Middle Name:
Last Name:FRASER
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PINE AVE STE 609
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2310
Mailing Address - Country:US
Mailing Address - Phone:270-792-7190
Mailing Address - Fax:
Practice Address - Street 1:320 PINE AVE STE 609
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-2310
Practice Address - Country:US
Practice Address - Phone:270-792-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant