Healthcare Provider Details

I. General information

NPI: 1508159930
Provider Name (Legal Business Name): KAREN E FRYE D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 N 9TH ST
GRAND JUNCTION CO
81501-2923
US

IV. Provider business mailing address

1925 N 9TH ST
GRAND JUNCTION CO
81501-2923
US

V. Phone/Fax

Practice location:
  • Phone: 206-755-1787
  • Fax:
Mailing address:
  • Phone: 206-755-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDR.0053532
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0053532
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: