Provider Demographics
NPI:1942397930
Name:FRASER, KENNETH ROBERT (KENNETH FRASER MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROBERT
Last Name:FRASER
Suffix:
Gender:M
Credentials:KENNETH FRASER MD
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:ROBERT
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KENNETH FRASER MD
Mailing Address - Street 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5648
Mailing Address - Country:US
Mailing Address - Phone:480-949-5886
Mailing Address - Fax:480-949-8018
Practice Address - Street 1:3501 NORTH SCOTTSDALE ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5632
Practice Address - Country:US
Practice Address - Phone:480-949-5886
Practice Address - Fax:480-949-8018
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7913207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ232653Medicaid
AZC99492Medicare UPIN