MEDICARE: DR. VINCENT LUCAS DAVID FRYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	76784	AZ
2	2084P0015X	Psychosomatic Medicine Physician	76784	AZ

General Provider Information

NPI Number	:	1073017265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT LUCAS DAVID FRYER MD

Provider Business Mailing Address
First Line	:	3830 N WINDSONG DR APT 2206
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-0170
Country	:	US
Telephone Number	:	801-554-4882
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 WHIPPLE ST
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1705
Country	:	US
Telephone Number	:	928-445-5211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	10/29/2025

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