Provider Demographics
NPI:1386827137
Name:DAVID G FRYE PC
Entity Type:Organization
Organization Name:DAVID G FRYE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-243-7900
Mailing Address - Street 1:4300 CASCADE RD SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3631
Mailing Address - Country:US
Mailing Address - Phone:616-243-7900
Mailing Address - Fax:616-243-8299
Practice Address - Street 1:4300 CASCADE RD SE
Practice Address - Street 2:SUITE 103
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3631
Practice Address - Country:US
Practice Address - Phone:616-243-7900
Practice Address - Fax:616-243-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDF007503207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX IDENTIFICATION