Provider Demographics
NPI:1710112123
Name:FRASER, DANIEL
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:FRASER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 LONE OAK RD
Mailing Address - Street 2:STE. 345
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7913
Mailing Address - Country:US
Mailing Address - Phone:270-538-5800
Mailing Address - Fax:270-538-5801
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:STE. 230
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7913
Practice Address - Country:US
Practice Address - Phone:270-538-5800
Practice Address - Fax:270-538-5801
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00931Medicare UPIN