Provider Demographics
NPI:1285927509
Name:FRYE, TIFFANY LYNN (DO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYNN
Last Name:FRYE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37491 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013-4379
Mailing Address - Country:US
Mailing Address - Phone:530-999-9030
Mailing Address - Fax:
Practice Address - Street 1:37491 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4379
Practice Address - Country:US
Practice Address - Phone:309-999-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB12377500208000000X
NMA-1815-14208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics