Provider Demographics
NPI:1518928837
Name:FRYE, ALFRED R (DO)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:R
Last Name:FRYE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2619
Mailing Address - Country:US
Mailing Address - Phone:803-782-4278
Mailing Address - Fax:803-253-8896
Practice Address - Street 1:511 BELTLINE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3627
Practice Address - Country:US
Practice Address - Phone:803-782-4051
Practice Address - Fax:803-790-6612
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC002464Medicaid
F33522Medicare UPIN
SC002464Medicaid