Provider Demographics
NPI:1609983725
Name:FRASER, LIONEL B JR (MD)
Entity Type:Individual
Prefix:MR
First Name:LIONEL
Middle Name:B
Last Name:FRASER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 23666
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3666
Mailing Address - Country:US
Mailing Address - Phone:601-200-4749
Mailing Address - Fax:601-200-5929
Practice Address - Street 1:971 LAKELAND DR STE 360
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4607
Practice Address - Country:US
Practice Address - Phone:601-200-4370
Practice Address - Fax:601-200-4375
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS09524208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0011047Medicaid
B30885Medicare UPIN
MS0011047Medicaid