Provider Demographics
NPI:1164299202
Name:FRASER, JOHN THOMAS
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:FRASER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E PETTIGREW ST APT 442
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3887
Mailing Address - Country:US
Mailing Address - Phone:919-704-0517
Mailing Address - Fax:
Practice Address - Street 1:100 DUKE HEALTH CARY PL STE 110
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6760
Practice Address - Country:US
Practice Address - Phone:919-385-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily