Healthcare Provider Details

I. General information

NPI: 1124097167
Provider Name (Legal Business Name): BRUCE BRIAN FRY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 FORT SANDERS WEST BLVD
KNOXVILLE TN
37922-3355
US

IV. Provider business mailing address

8320 E WALKER SPRINGS LN STE 200
KNOXVILLE TN
37923-3120
US

V. Phone/Fax

Practice location:
  • Phone: 865-558-4400
  • Fax: 865-769-4536
Mailing address:
  • Phone: 865-769-4500
  • Fax: 865-769-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1406
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number1406
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: