Provider Demographics
NPI:1124097167
Name:FRY, BRUCE BRIAN (DO)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:BRIAN
Last Name:FRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 FORT SANDERS WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-769-4500
Mailing Address - Fax:865-769-4557
Practice Address - Street 1:260 FORT SANDERS WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-558-4400
Practice Address - Fax:865-769-4536
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1406208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3306949Medicaid
TNTN01A9OtherJOHN DEERE HEALTHCARE
TN4028311OtherBLUE CROSS BLUE SHIELD
TN2340066OtherUNITED HEALTH CARE
TN250014223OtherRAILROAD MEDICARE
TNTN01B1OtherJOHN DEERE HEALTHCARE
TN33069491Medicare PIN
TN4028311OtherBLUE CROSS BLUE SHIELD
TN3306949Medicaid
TN2340066OtherUNITED HEALTH CARE
TN3711675Medicare PIN
TNTN01A9OtherJOHN DEERE HEALTHCARE