Organization
MEDICAL INJURY CARE PROVIDER NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OWEN D FRASER MD (PRESIDENT)
(407) 351-1095
Entity
Organization
Contact information
Practice address
1805 W COLONIAL DR STE A, ORLANDO, FL 32804-7011
(407) 578-9142
Mailing address
1805 W COLONIAL DR STE A, ORLANDO, FL 32804-7011
(407) 578-9142
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
11/28/2018
Last updated
11/28/2018
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