Provider Demographics
NPI:1598822207
Name:FRYER, STEPHEN FULLER (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FULLER
Last Name:FRYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:S.
Other - Middle Name:CASEY
Other - Last Name:FRYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0763
Mailing Address - Country:US
Mailing Address - Phone:800-541-4009
Mailing Address - Fax:
Practice Address - Street 1:120 MEDICAL PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9012
Practice Address - Country:US
Practice Address - Phone:304-624-7200
Practice Address - Fax:304-423-5302
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV2006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2652133Medicaid
WV3810002530Medicaid
WVWV2750AMedicare PIN
WV3810002530Medicaid
I19678Medicare UPIN