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NPI Code Detail

MEDICARE: MR. BRIAN DOUGLAS FRYE ATC

MEDICARE: MR. BRIAN DOUGLAS FRYE ATC
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
12255A2300XAthletic TrainerAL0001135FL

General Provider Information

NPI Number : 1689792236
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN DOUGLAS FRYE ATC
Provider Business Mailing Address
First Line : 7920 MERRILL RD
Second Line : UNIT 1212
City : JACKSONVILLE
State : FL
Zip : 32277-6549
Country : US
Telephone Number : 904-762-1227
Fax Number :
Provider Business Practice Location Address
First Line : 2800 UNIVERSITY BLVD N
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-3321
Country : US
Telephone Number : 904-256-7714
Fax Number : 904-256-7424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 07/08/2007

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