Provider Demographics
NPI:1568437408
Name:FRY, WILLIAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:FRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2222 N NEVADA AVE STE 5010
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6865
Mailing Address - Country:US
Mailing Address - Phone:719-776-6700
Mailing Address - Fax:719-776-6780
Practice Address - Street 1:2222 N NEVADA AVE STE 5010
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6865
Practice Address - Country:US
Practice Address - Phone:719-776-6700
Practice Address - Fax:719-776-6780
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244709208600000X, 2086S0102X, 2086S0129X
SC35294208600000X, 2086S0102X, 2086S0129X
CODR.00336112086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1568437408Medicaid
SC352942Medicaid
CO01336114Medicaid
020024496OtherRAILROAD MEDICARE
SCSC06041955Medicare PIN
020024496OtherRAILROAD MEDICARE
VAMC12679Medicare PIN
VAP00763824Medicare PIN