Individual
JOHN JOSEPH FRASER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11398 BANDERA RD STE 201, SAN ANTONIO, TX 78250-6827
(210) 543-7334
Mailing address
301 UNIVERSITY BLVD, PROVIDER ENROLLMENT-RT. 1022, GALVESTON, TX 77555-5302
(409) 747-0890
(409) 772-0885
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
F3966
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138402603
—
TX
05
—
138402613
—
TX
01
—
81Z135
BLUE CROSS BLUE SHIELD OF TEXAS
TX
Enumeration date
06/12/2006
Last updated
08/29/2013
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