Healthcare Provider Details

I. General information

NPI: 1346366614
Provider Name (Legal Business Name): KATHLEEN KOLT FRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN ANN KOLT MD

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9522 E SAN SALVADOR DR SUITE 203
SCOTTSDALE AZ
85258-5557
US

IV. Provider business mailing address

9522 E SAN SALVADOR DR SUITE 203
SCOTTSDALE AZ
85258-5557
US

V. Phone/Fax

Practice location:
  • Phone: 480-947-1545
  • Fax: 480-947-2392
Mailing address:
  • Phone: 480-947-1545
  • Fax: 480-947-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number15481
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: