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Individual

MR. JOHN PHILLIP FRASURE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
208 HALEY RD, JOHNSON CITY, TX 78636-4617
(830) 868-4033
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1049273
363A00000X
Physician Assistant
Primary
PA05105
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA05105
STATE LICENSE
TX
Enumeration date
02/02/2006
Last updated
12/08/2021
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