Healthcare Provider Details

I. General information

NPI: 1518565696
Provider Name (Legal Business Name): AARON R FRY CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 N 16TH ST
PHOENIX AZ
85016-5338
US

IV. Provider business mailing address

4343 N 16TH ST
PHOENIX AZ
85016-5338
US

V. Phone/Fax

Practice location:
  • Phone: 602-741-3610
  • Fax:
Mailing address:
  • Phone: 602-274-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: