Provider Demographics
NPI:1588632384
Name:FRASER, ROSALINE O (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSALINE
Middle Name:O
Last Name:FRASER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSALINE
Other - Middle Name:O
Other - Last Name:FRASER
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:620 W GROVE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4462
Mailing Address - Country:US
Mailing Address - Phone:870-875-5500
Mailing Address - Fax:870-875-5507
Practice Address - Street 1:620 W GROVE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4462
Practice Address - Country:US
Practice Address - Phone:870-875-5500
Practice Address - Fax:870-875-5507
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD829902101Medicaid
MD829902101Medicaid
MDG92225Medicare UPIN