Provider Demographics
NPI:1922140482
Name:FRASER, GORDON CLELAND (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:CLELAND
Last Name:FRASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8475 S VAN NESS AVE
Mailing Address - Street 2:STE 104 GORDON C FRAZER MD INC
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305
Mailing Address - Country:US
Mailing Address - Phone:323-752-3327
Mailing Address - Fax:323-751-8470
Practice Address - Street 1:8475 S VAN NESS AVE
Practice Address - Street 2:STE 104 GORDON C FRAZER MD INC
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305
Practice Address - Country:US
Practice Address - Phone:323-752-3327
Practice Address - Fax:323-751-8470
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30690207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOC306901Medicaid