Provider Demographics
NPI:1407943194
Name:FRY, MICHAEL F (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
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 1:4828 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:1955 TEXTILE WAY STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2543
Practice Address - Country:US
Practice Address - Phone:678-987-1499
Practice Address - Fax:678-987-1498
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032418207RG0100X
GA82069207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2253483OtherCIGNA
000231884004OtherUNITED HEALTH CARE
FL037199800Medicaid
AL009509880Medicaid
AL059123840OtherBCBS OF ALABAMA
4384517OtherAETNA
Z018OtherHEALTH OPTIONS
FL17413OtherBCBS OF FLORIDA
100007815OtherRAILROAD MEDICARE
FL037199800Medicaid
FL17413ZMedicare PIN
AL000050731Medicare PIN