Provider Demographics
NPI:1962832790
Name:OBSTETRICS & GYNECOLOGY OF SCOTTSDALE, LTD
Entity Type:Organization
Organization Name:OBSTETRICS & GYNECOLOGY OF SCOTTSDALE, LTD
Other - Org Name:KENNETH FRASER MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-949-5886
Mailing Address - Street 1:3501 NORTH SCOTTSDALE ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5632
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7913207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty