Provider Demographics
NPI:1568679678
Name:FRY, ERIN (DO)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:FRY
Suffix:
Gender:F
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 1:2860 S CIRCLE DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4113
Mailing Address - Country:US
Mailing Address - Phone:719-473-2346
Mailing Address - Fax:719-577-9627
Practice Address - Street 1:2860 S CIRCLE DR
Practice Address - Street 2:SUITE 160
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4113
Practice Address - Country:US
Practice Address - Phone:719-473-2346
Practice Address - Fax:719-577-9627
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010157132084P0800X
CO482012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC36019116Medicare PIN