Healthcare Provider Details

I. General information

NPI: 1154245512
Provider Name (Legal Business Name): JOHN WILLIAM DURK FRYE III PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 LONE TREE WAY
ANTIOCH CA
94509-6200
US

IV. Provider business mailing address

2519 CLEMENT AVE
ALAMEDA CA
94501-1522
US

V. Phone/Fax

Practice location:
  • Phone: 415-361-3976
  • Fax:
Mailing address:
  • Phone: 559-240-2428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: