Provider Demographics
NPI:1801887476
Name:FRASER, DAVID B (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:FRASER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19876 SAINT JOSEPH DR
Mailing Address - Street 2:CENTERVILLE MEDICAL CLINIC
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-8850
Mailing Address - Country:US
Mailing Address - Phone:641-856-8684
Mailing Address - Fax:641-856-3009
Practice Address - Street 1:19942 SAINT JOSEPH DR
Practice Address - Street 2:CENTERVILLE MEDICAL CLINIC
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-8849
Practice Address - Country:US
Practice Address - Phone:641-856-8684
Practice Address - Fax:641-856-3009
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2019-02-14
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Provider Licenses
StateLicense IDTaxonomies
IA24957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2023317Medicaid
IAP00000619OtherRR MEDICARE
IAI8379Medicare PIN
A02963Medicare UPIN