MEDICARE: MS. CYNTHIA LEE FRY-SPRAY PA-C

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	363AS0400X	Surgical Physician Assistant	PA10003795	WA

General Provider Information

NPI Number	:	1578547436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA LEE FRY-SPRAY PA-C

Provider Business Mailing Address
First Line	:	30023 6TH AVE SW
Second Line	:
City	:	FEDERAL WAY
State	:	WA
Zip	:	98023-3520
Country	:	US
Telephone Number	:	253-941-2943
Fax Number	:

Provider Business Practice Location Address
First Line	:	691 BARNES BLVD
Second Line	:
City	:	MCCHORD AFB
State	:	WA
Zip	:	98438
Country	:	US
Telephone Number	:	253-982-3518
Fax Number	:

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/08/2007

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