Provider Demographics
NPI:1538171301
Name:FRASER, EDWARD KENNETH (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:KENNETH
Last Name:FRASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6035 CYPRESS GARDENS BLVD
Mailing Address - Street 2:SE WINTER HAVEN FAMILY HEALTH CENTER
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884
Mailing Address - Country:US
Mailing Address - Phone:863-324-4725
Mailing Address - Fax:863-324-4783
Practice Address - Street 1:6035 CYPRESS GARDENS BLVD
Practice Address - Street 2:SE WINTER HAVEN FAMILY HEALTH CENTER
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884
Practice Address - Country:US
Practice Address - Phone:863-324-4725
Practice Address - Fax:863-324-4783
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine