Active NPI
Brian J Fraser, PATHOLOGY ASSISTANT
- Physician Assistant
- Sioux Falls, SD
National Provider Identifier
1679765192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0058
- Practice address
- 1305 W 18TH St
Sioux Falls, SD 57105-0401 - Phone
- (605) 333-1720
- Fax
- (605) 333-1966
- NPI assigned
- Aug 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology Physician | 207ZP0101X | 0058 | SD | |
| Physician Assistant | 363A00000X | 0058 | SD | Primary |
Addresses
Primary practice location
1305 W 18TH St
Sioux Falls, SD 57105-0401
Mailing address
1305 W 18TH St
Sioux Falls, SD 57105-0401
Phone (605) 333-1720
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0058 | Other | SD | PHYSICIAN ASSISTANT CERTI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187308800000",
"number": "1679765192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1305 W 18TH ST",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571050401",
"telephone_number": "605-333-1720",
"fax_number": "605-333-1966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 W 18TH ST",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571050401",
"telephone_number": "605-333-1720",
"fax_number": "605-333-1966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRASER",
"first_name": "BRIAN",
"middle_name": "J",
"credential": "PATHOLOGY ASSISTANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-17",
"last_updated": "2007-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "SD",
"license": "0058",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SD",
"license": "0058",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIAN ASSISTANT CERTI",
"identifier": "0058",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sioux Falls, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.