Basic Information
Provider Information
NPI: 1487970596
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRASER
FirstName: JAMIE
MiddleName: LEE
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 111 MICHIGAN AVE NW
Address2: DIVISION OF GENETICS AND METABOLISM
City: WASHINGTON
State: DC
PostalCode: 200102916
CountryCode: US
TelephoneNumber: 2024765000
FaxNumber: 2024765000
Practice Location
Address1: 111 MICHIGAN AVE NW
Address2: DIVISION OF GENETICS AND METABOLISM
City: WASHINGTON
State: DC
PostalCode: 200102916
CountryCode: US
TelephoneNumber: 2024765000
FaxNumber: 2024765000
Other Information
ProviderEnumerationDate: 04/14/2010
LastUpdateDate: 08/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207SG0201XMD040659DCY Allopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)

No ID Information.


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