Provider Demographics
NPI:1417940602
Name:FRASER, ALEX IAN (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:IAN
Last Name:FRASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3969 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-4810
Mailing Address - Country:US
Mailing Address - Phone:317-816-6924
Mailing Address - Fax:195-265-8195
Practice Address - Street 1:3969 CHADWICK DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-4810
Practice Address - Country:US
Practice Address - Phone:317-816-6924
Practice Address - Fax:195-265-8195
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17685207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05187OtherWELLMARK BCBS
IA0478982Medicaid
IAI16783Medicare PIN
IAP00335065Medicare PIN
IA0478982Medicaid