Provider Demographics
NPI:1619972759
Name:FRYE, TIMOTHY A (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:FRYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:50 MEDICAL PARK DR E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3401
Practice Address - Country:US
Practice Address - Phone:205-838-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL186562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938811Medicaid
AL009938808Medicaid
AL051504476Medicaid
AL051510987OtherBLUE CROSS
AL051512408OtherBLUE CROSS
AL009938809Medicaid
AL009938806Medicaid
AL051504477OtherBLUE CROSS
AL009938804Medicaid
AL051512410OtherBLUE CROSS
AL051512700OtherBLUE CROSS
AL009938803Medicaid
AL009985795Medicaid
AL051504479OtherBLUE CROSS
AL051539874OtherBLUE CROSS
AL009938807Medicaid
AL051504476OtherBLUE CROSS
AL051504480OtherBLUE CROSS
AL051525167OtherBLUE CROSS
AL4281297OtherAETNA
AL009938804Medicaid
AL009938803Medicaid
AL009938807Medicaid
AL051554739Medicare PIN