Provider Demographics
NPI:1083874267
Name:MATOUSEK-FRASER, SARAH BETH (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:MATOUSEK-FRASER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:BETH
Other - Last Name:MATOUSEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-977-1864
Mailing Address - Fax:580-977-1865
Practice Address - Street 1:620 S MADISON ST STE 209
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7270
Practice Address - Country:US
Practice Address - Phone:580-977-1864
Practice Address - Fax:580-977-1865
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26426207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine