Provider Demographics
NPI:1346366614
Name:FRY, KATHLEEN KOLT (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:KOLT
Last Name:FRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:KOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9522 E SAN SALVADOR DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5557
Mailing Address - Country:US
Mailing Address - Phone:480-947-1545
Mailing Address - Fax:480-947-2392
Practice Address - Street 1:9522 E SAN SALVADOR DR
Practice Address - Street 2:SUITE 203
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5557
Practice Address - Country:US
Practice Address - Phone:480-947-1545
Practice Address - Fax:480-947-2392
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15481207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD43931Medicare UPIN