Provider Demographics
NPI:1144203134
Name:FRY, PAUL JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JEFFREY
Last Name:FRY
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 1:2006 FRANKLIN ST SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4551
Mailing Address - Country:US
Mailing Address - Phone:256-539-0457
Mailing Address - Fax:256-539-5827
Practice Address - Street 1:2006 FRANKLIN ST SE
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4551
Practice Address - Country:US
Practice Address - Phone:256-539-0457
Practice Address - Fax:256-539-5827
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA740072085R0202X
AL150452085R0202X
TN303122085R0202X
AL180862085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911116Medicaid
AL009942878Medicaid
AL135866Medicaid
AL247706Medicaid
AL247866Medicaid
AL51057219OtherBCBS
AL51057271OtherBCBS
AL51100053OtherBCBS
AL57270Medicaid
AL57271Medicaid
AL51057272OtherBCBS
AL57219Medicaid
AL890-51501OtherBCBS
AL57272Medicaid
AL247645Medicaid
AL51595663OtherBCBS
AL212149Medicaid
AL247545Medicaid
AL248105Medicaid
AL248673Medicaid
TN4011004OtherBCBS
AL890-43468OtherBCBS
10910913OtherCAQH
AL126703Medicaid
AL240071Medicaid
AL51057270OtherBCBS
AL511-23900OtherBCBS
AL51590038OtherBCBS