Basic Information
Provider Information
NPI: 1255377503
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRASER
FirstName: WILLIAM
MiddleName: RANDOLPH
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 505 S 336TH ST
Address2: SUITE 600
City: FEDERAL WAY
State: WA
PostalCode: 98003
CountryCode: US
TelephoneNumber: 2538386180
FaxNumber: 2538386418
Practice Location
Address1: 930 SW ABBEY ST
Address2:  
City: NEWPORT
State: OR
PostalCode: 973654820
CountryCode: US
TelephoneNumber: 5412652244
FaxNumber: 5415741831
Other Information
ProviderEnumerationDate: 06/22/2006
LastUpdateDate: 11/03/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/03/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XMD16858ORY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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