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General NPI Number Information
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NPI Number | 1679738504
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Entity Type | Individual
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Provider Name | ROBERT W.E. FRY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 1111 LAS TABLAS RD STE R
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City | TEMPLETON
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State | CA
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Zip | 93465-9732
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Country | US
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Telephone | 805-434-4848
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Fax | 855-902-6131
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Provider Business Mailing Address
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Address Line | 1111 LAS TABLAS RD STE R
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City | TEMPLETON
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State | CA
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Zip | 93465-9732
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Country | US
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Telephone | 805-434-4848
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A115889
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License Number State | CA
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