Individual
FRASER G TUDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
917 W WALNUT ST, JOHNSON CITY, TN 37604-6527
(423) 439-6464
(423) 439-7118
Mailing address
P.O. BOX 699, MOUNTAIN HOME, TN 37684
(423) 439-6464
(423) 439-7118
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36003
TN
Other
Enumeration date
12/22/2005
Last updated
11/08/2010
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