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General NPI Number Information
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NPI Number | 1598822207
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Entity Type | Individual
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Provider Name | STEPHEN FULLER FRYER D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 120 MEDICAL PARK DR SUITE 300
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City | BRIDGEPORT
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State | WV
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Zip | 26330-9012
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Country | US
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Telephone | 304-624-7200
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Fax | 304-423-5302
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Provider Business Mailing Address
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Address Line | PO BOX 763
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City | MORGANTOWN
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State | WV
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Zip | 26507-0763
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Country | US
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Telephone | 800-541-4009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | WV2006
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License Number State | WV
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