Provider Demographics
NPI:1336339118
Name:FRASER, AUSTIN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:MICHAEL
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 1:111 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE #404
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3028
Mailing Address - Country:US
Mailing Address - Phone:504-899-1120
Mailing Address - Fax:504-899-2432
Practice Address - Street 1:111 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE #404
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3028
Practice Address - Country:US
Practice Address - Phone:504-899-1120
Practice Address - Fax:504-899-2432
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203003207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1000701Medicaid
MS00628568Medicaid
LA4P3607061Medicare PIN