MEDICARE: DR. MICHAEL REED FRY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	1285011577	WA
2	207R00000X	Internal Medicine Physician	CDRH.0070260	CO
3	390200000X	Student in an Organized Health Care Education/Training Program
4	208M00000X	Hospitalist Physician	O-1133	ID

General Provider Information

NPI Number	:	1285011577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL REED FRY DO

Provider Business Mailing Address
First Line	:	812 ROEHAMPTON CT
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-2893
Country	:	US
Telephone Number	:	360-689-6462
Fax Number	:	719-698-7879

Provider Business Practice Location Address
First Line	:	1465 KELLY JOHNSON BLVD STE 310
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3947
Country	:	US
Telephone Number	:	360-689-6462
Fax Number	:	719-698-7879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	12/24/2024

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