Provider Demographics
NPI:1386761153
Name:FRYE, REBECCA ANN KRUTZ (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN KRUTZ
Last Name:FRYE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:KRUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:701 E BRIDGER AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-5554
Mailing Address - Country:US
Mailing Address - Phone:267-977-3215
Mailing Address - Fax:
Practice Address - Street 1:701 E BRIDGER AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-5554
Practice Address - Country:US
Practice Address - Phone:267-977-3215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9884207Q00000X
NVDO1751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine