Provider Demographics
NPI:1740394220
Name:FRAGER, MARC STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:STEPHEN
Last Name:FRAGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 NW 10TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1312
Mailing Address - Country:US
Mailing Address - Phone:561-391-1085
Mailing Address - Fax:561-391-1449
Practice Address - Street 1:1500 NW 10TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1312
Practice Address - Country:US
Practice Address - Phone:561-391-1085
Practice Address - Fax:561-391-1449
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36628174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57119Medicare UPIN
FL61141Medicare ID - Type Unspecified