Provider Demographics
NPI:1972528966
Name:FRY, FRED M (MD)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:M
Last Name:FRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FRED
Other - Middle Name:M
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2501 N NAVARRO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3912
Mailing Address - Country:US
Mailing Address - Phone:361-573-6351
Mailing Address - Fax:361-575-6455
Practice Address - Street 1:2501 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3912
Practice Address - Country:US
Practice Address - Phone:361-573-6351
Practice Address - Fax:361-575-6455
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6266208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K800OtherBLUECROSS BLUESHIELD
TX4378838OtherUNITED HEALTHCARE
TX4378838OtherAETNA
TX4378838OtherUNITED HEALTHCARE
TX4378838OtherAETNA