Provider Demographics
NPI:1205858776
Name:FRY, LUTHER L (MD)
Entity Type:Individual
Prefix:
First Name:LUTHER
Middle Name:L
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 1:310 E WALNUT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5560
Mailing Address - Country:US
Mailing Address - Phone:620-275-7248
Mailing Address - Fax:620-275-5262
Practice Address - Street 1:310 E WALNUT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5560
Practice Address - Country:US
Practice Address - Phone:620-275-7248
Practice Address - Fax:620-275-5262
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS13952207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100082380AMedicaid
OK100192960AMedicaid
CO91139527Medicaid
OK100192960AMedicaid
KS024864Medicare ID - Type Unspecified
KS181496443Medicare ID - Type UnspecifiedRR MEDICARE