Healthcare Provider Details

I. General information

NPI: 1285011577
Provider Name (Legal Business Name): MICHAEL REED FRY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL REED FRY DO

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 KELLY JOHNSON BLVD STE 310
COLORADO SPRINGS CO
80920-3947
US

IV. Provider business mailing address

812 ROEHAMPTON CT
MONUMENT CO
80132-2893
US

V. Phone/Fax

Practice location:
  • Phone: 360-689-6462
  • Fax: 719-698-7879
Mailing address:
  • Phone: 360-689-6462
  • Fax: 719-698-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1285011577
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberCDRH.0070260
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberO-1133
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: