Provider Demographics
NPI:1164489613
Name:FRAKER, LESA DEANNE (MD PHD)
Entity Type:Individual
Prefix:MS
First Name:LESA
Middle Name:DEANNE
Last Name:FRAKER
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 PASEO DE PERALTA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501
Mailing Address - Country:US
Mailing Address - Phone:505-989-8707
Mailing Address - Fax:505-989-3536
Practice Address - Street 1:707 PASEO DE PERALTA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501
Practice Address - Country:US
Practice Address - Phone:505-989-8707
Practice Address - Fax:505-989-3536
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2008-01-30
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-01-30
Provider Licenses
StateLicense IDTaxonomies
NM9751207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I0479Medicare UPIN