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General NPI Number Information
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NPI Number | 1457515744
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Entity Type | Organization
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Legal Business Name | FRY LABORATORIES LLC
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 14807 N 73RD ST #103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 480-292-8560
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Fax | 480-222-1142
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Provider Business Mailing Address
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Address Line | 14807 N 73RD ST #103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 480-292-8560
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Fax | 480-222-1142
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN EUGENE FRY
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Credential | MD
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Telephone | 480-292-8560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 1030708
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License Number State | AZ
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