Provider Demographics
NPI:1962576959
Name:FRYER, KENNETH B (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:FRYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 MEINECKE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1721
Mailing Address - Country:US
Mailing Address - Phone:805-541-4600
Mailing Address - Fax:805-541-3566
Practice Address - Street 1:862 MEINECKE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1721
Practice Address - Country:US
Practice Address - Phone:805-541-4600
Practice Address - Fax:805-541-3293
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21824207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14365Medicare ID - Type Unspecified
CAA41396Medicare UPIN