Healthcare Provider Details

I. General information

NPI: 1972577195
Provider Name (Legal Business Name): SCOTT T FRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NE 5TH AVE
MILTON FREEWATER OR
97862-1702
US

IV. Provider business mailing address

55 W TIETAN ST
WALLA WALLA WA
99362-4445
US

V. Phone/Fax

Practice location:
  • Phone: 541-938-3314
  • Fax: 541-938-4449
Mailing address:
  • Phone: 509-525-3720
  • Fax: 509-522-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00043909
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: