Healthcare Provider Details

I. General information

NPI: 1356501092
Provider Name (Legal Business Name): RICHARD C. FRIES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FELIKS GWOZDZ PL
FORT WORTH TX
76104-4919
US

IV. Provider business mailing address

3248 W 7TH ST APT 331
FORT WORTH TX
76107-2768
US

V. Phone/Fax

Practice location:
  • Phone: 817-920-5700
  • Fax:
Mailing address:
  • Phone: 817-353-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberP7914
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: