Provider Demographics
NPI:1255667523
Name:FRYER, REX LYNN (MED)
Entity Type:Individual
Prefix:MR
First Name:REX
Middle Name:LYNN
Last Name:FRYER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1069
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73023-1069
Mailing Address - Country:US
Mailing Address - Phone:405-224-8111
Mailing Address - Fax:405-574-7765
Practice Address - Street 1:2222 WEST IOWA AVENUE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2738
Practice Address - Country:US
Practice Address - Phone:405-224-8111
Practice Address - Fax:405-574-7765
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK604101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor