Provider Demographics
NPI:1376662213
Name:FRY, RAMON E II (PA)
Entity Type:Individual
Prefix:MR
First Name:RAMON
Middle Name:E
Last Name:FRY
Suffix:II
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARL R. DARNALL ARMY MEDICAL CENTER
Mailing Address - Street 2:590 MEDICAL CENTER ROAD, ATTN: EMERGENCY DEPARTMENT
Mailing Address - City:FORT CAVAZOS
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5060
Mailing Address - Country:US
Mailing Address - Phone:254-288-8338
Mailing Address - Fax:
Practice Address - Street 1:CARL R. DARNALL ARMY MEDICAL CENTER
Practice Address - Street 2:ATTN: EMERGENCY DEPARTMENT
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057857363AM0700X
TXPA06210363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347137YLLYMedicare PIN