1831487255 NPI number — FRYE MEDICAL GROUP, PLLC

Table of content: (NPI 1831487255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831487255 NPI number — FRYE MEDICAL GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRYE MEDICAL GROUP, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1831487255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 PINEHILL TRL W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEQUESTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33469-2158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-601-9393
Provider Business Mailing Address Fax Number:
561-746-1522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 HERITAGE DR STE 455
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-2777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-601-9393
Provider Business Practice Location Address Fax Number:
561-746-1522
Provider Enumeration Date:
07/19/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FRYE
Authorized Official First Name:
DARRIN
Authorized Official Middle Name:
LYLE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-601-9393

Provider Taxonomy Codes

  • Taxonomy code: 2083P0901X , with the licence number:  ME0070655 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)