Individual
MALCOLM R FRASER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
605 LAMAR AVE, BROOKSVILLE, FL 34601-3211
(352) 799-5411
(352) 544-2713
Mailing address
605 LAMAR AVE, BROOKSVILLE, FL 34601-3211
(352) 799-5411
(352) 544-2713
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
ME36199
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010065834
RAILROAD MEDICARE
FL
01
—
010066083
RAILROAD MEDICARE
FL
01
—
010066171
RAILROAD MEDICARE
FL
05
—
039210300
—
FL
01
—
62242
BC/BS FLA
FL
Enumeration date
09/01/2005
Last updated
09/22/2014
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