MEDICARE: DR. ROBERT W.E. FRY M.D.

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	207X00000X	Orthopaedic Surgery Physician	A115889	CA

General Provider Information

NPI Number	:	1679738504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT W.E. FRY M.D.

Provider Business Mailing Address
First Line	:	1111 LAS TABLAS RD STE R
Second Line	:
City	:	TEMPLETON
State	:	CA
Zip	:	93465-9732
Country	:	US
Telephone Number	:	805-434-4848
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 LAS TABLAS RD STE R
Second Line	:
City	:	TEMPLETON
State	:	CA
Zip	:	93465-9732
Country	:	US
Telephone Number	:	805-434-4848
Fax Number	:	855-902-6131

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	10/21/2019

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