Provider Demographics
NPI:1790792380
Name:FRASER, JEFFREY L (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:FRASER
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-0068
Mailing Address - Country:US
Mailing Address - Phone:252-247-3257
Mailing Address - Fax:252-247-1076
Practice Address - Street 1:4218 ARENDELL ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2866
Practice Address - Country:US
Practice Address - Phone:252-247-3265
Practice Address - Fax:252-247-1076
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19664207Q00000X
NC2020-04208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03137OtherBCBS - LINC CARE
NE10026146200Medicaid
NE500317OtherBCBS
NE01-00470OtherUHC
NE3850OtherMIDLAND'S CHOICE
NE03137OtherBCBS - LINC CARE
E24274Medicare UPIN
080064629Medicare PIN
265434Medicare PIN