Healthcare Provider Details

I. General information

NPI: 1619670262
Provider Name (Legal Business Name): NOAH ROBERT FRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 FAIRMONT PKWY
PASADENA TX
77504-3013
US

IV. Provider business mailing address

1 BAYLOR PLZ # BCM320
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 713-873-6300
  • Fax:
Mailing address:
  • Phone: 832-824-1170
  • Fax: 832-825-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW3257
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: