Healthcare Provider Details

I. General information

NPI: 1891784542
Provider Name (Legal Business Name): DAVID GORDON FRYE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 CASCADE RD SE SUITE 103
GRAND RAPIDS MI
49546-3631
US

IV. Provider business mailing address

4300 CASCADE RD SE SUITE 103
GRAND RAPIDS MI
49546-3631
US

V. Phone/Fax

Practice location:
  • Phone: 616-243-7900
  • Fax: 616-243-8299
Mailing address:
  • Phone: 616-243-7900
  • Fax: 616-243-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDF007503
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: