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NPI Code Detail

MEDICARE: BRADLEY C FRY MD

MEDICARE: BRADLEY C FRY MD
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
1207L00000XAnesthesiology Physician16841TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376621607
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY C FRY MD
Provider Business Mailing Address
First Line : PO BOX 488
Second Line :
City : MADISON
State : TN
Zip : 37116-0488
Country : US
Telephone Number : 615-865-6268
Fax Number : 615-868-7378
Provider Business Practice Location Address
First Line : 154 CUDE LN
Second Line :
City : MADISON
State : TN
Zip : 37115-2202
Country : US
Telephone Number : 615-865-6268
Fax Number : 615-868-7378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 07/08/2007

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Directions to “ BRADLEY C FRY MD” Practice Location

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