Provider Demographics
NPI:1801835947
Name:FRASER, GRANT ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:ERNEST
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 1:1507 ROLLING HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:TN
Mailing Address - Zip Code:38585
Mailing Address - Country:US
Mailing Address - Phone:931-305-2475
Mailing Address - Fax:931-591-3353
Practice Address - Street 1:1507 ROLLING HILLS DRIVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:TN
Practice Address - Zip Code:38585
Practice Address - Country:US
Practice Address - Phone:931-305-2475
Practice Address - Fax:931-591-3353
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55281207P00000X, 207Q00000X
FLME92005207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272057400Medicaid
FLU4709BMedicare ID - Type Unspecified