Provider Demographics
NPI:1578516548
Name:FRAYSER, ROBERT LEE (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:FRAYSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 MASSACHUSETTS ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046
Mailing Address - Country:US
Mailing Address - Phone:785-832-4837
Mailing Address - Fax:
Practice Address - Street 1:2415 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046
Practice Address - Country:US
Practice Address - Phone:785-832-4837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5452722OtherCCN
AZ710935607OtherARIZONA FOUNDATION
AZAZ0734720OtherBLUE CROSS BLUE SHIELD
AZP00024147OtherRAILROAD MEDICARE
AZ2110081OtherFIRST HEALTH
AZ5280193OtherAETNA
AZ788945Medicaid
AZF13089OtherPHP COMMUNITY CONNECTION
AZ1Z4223OtherHEALTHNET
AZ21233109113OtherBEECHSTREET
AZP00024147OtherRAILROAD MEDICARE
AZ788945Medicaid