Healthcare Provider Details

I. General information

NPI: 1003494899
Provider Name (Legal Business Name): REBECCA LYNN FRYER GORDON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYNN FRYER DO

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BLUES LAKE PKWY
ROLLA MO
65401-8022
US

IV. Provider business mailing address

600 BLUES LAKE PKWY
ROLLA MO
65401-8022
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-8822
  • Fax: 573-202-2402
Mailing address:
  • Phone: 573-364-8822
  • Fax: 573-202-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023020151
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: