Provider Demographics
NPI:1336159102
Name:FRASER, TOBIN J (DO)
Entity Type:Individual
Prefix:DR
First Name:TOBIN
Middle Name:J
Last Name:FRASER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4290 COPPER RIDGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7205
Mailing Address - Country:US
Mailing Address - Phone:231-935-8930
Mailing Address - Fax:231-935-8811
Practice Address - Street 1:4290 COPPER RIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7205
Practice Address - Country:US
Practice Address - Phone:231-935-8930
Practice Address - Fax:231-935-8811
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITF013087207Q00000X
MI5101013087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG93402Medicare UPIN