Provider Demographics
NPI:1154905107
Name:FRYE, JASON ALLEN
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ALLEN
Last Name:FRYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 STOCKTRAIL AVE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3554
Mailing Address - Country:US
Mailing Address - Phone:307-688-1160
Mailing Address - Fax:
Practice Address - Street 1:502 STOCKTRAIL AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3554
Practice Address - Country:US
Practice Address - Phone:307-688-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic