Provider Demographics
NPI:1285011577
Name:FRY, MICHAEL REED (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:REED
Last Name:FRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:REED
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:812 ROEHAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-2893
Mailing Address - Country:US
Mailing Address - Phone:360-689-6462
Mailing Address - Fax:719-698-7879
Practice Address - Street 1:1465 KELLY JOHNSON BLVD STE 310
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3947
Practice Address - Country:US
Practice Address - Phone:360-689-6462
Practice Address - Fax:719-698-7879
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1285011577207R00000X
COCDRH.0070260207R00000X
390200000X
IDO-1133208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program