Provider Demographics
NPI:1598700189
Name:FRYE, JASON TODD (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:TODD
Last Name:FRYE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4838 E BASELINE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4671
Mailing Address - Country:US
Mailing Address - Phone:480-926-8000
Mailing Address - Fax:480-926-3445
Practice Address - Street 1:4838 E BASELINE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4671
Practice Address - Country:US
Practice Address - Phone:480-926-8000
Practice Address - Fax:480-926-3445
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2010-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZDO3495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH06471Medicare UPIN
AZZ66176Medicare PIN