Provider Demographics
NPI:1497888358
Name:PEDIATRIC ASSOCIATES OF BOWLING GREEN, LLC
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF BOWLING GREEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAHID
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-782-8700
Mailing Address - Street 1:1211 ASHLEY CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3383
Mailing Address - Country:US
Mailing Address - Phone:270-782-8700
Mailing Address - Fax:270-782-8704
Practice Address - Street 1:1211 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3383
Practice Address - Country:US
Practice Address - Phone:270-782-8700
Practice Address - Fax:270-782-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty