Active NPI
Andrew Fraser
- Medical Physician Assistant
- Portland, OR
National Provider Identifier
1720436611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA184554
- Practice address
- 4411 SW Vermont St
Portland, OR 97219-1020 - Phone
- (503) 494-9992
- Fax
- (503) 494-1967
- NPI assigned
- Jun 1, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Medical Physician Assistant | 363AM0700X | PA184554 | OR | Primary |
Addresses
Primary practice location
4411 SW Vermont St
Portland, OR 97219-1020
Mailing address
4411 SW Vermont St
Portland, OR 97219-1020
Phone (503) 494-9992
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA184554 | OR | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636588800000",
"number": "1720436611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4411 SW VERMONT ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972191020",
"telephone_number": "503-494-9992",
"fax_number": "503-494-1967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4411 SW VERMONT ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972191020",
"telephone_number": "503-494-9992",
"fax_number": "503-494-1967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRASER",
"first_name": "ANDREW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-01",
"last_updated": "2021-11-11",
"certification_date": "2021-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OR",
"license": "PA184554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.