Provider Demographics
NPI:1639119274
Name:FRYE, LYNDA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:L
Last Name:FRYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1640 NEWPORT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3786
Mailing Address - Country:US
Mailing Address - Phone:877-277-8271
Mailing Address - Fax:949-706-6356
Practice Address - Street 1:1640 NEWPORT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3786
Practice Address - Country:US
Practice Address - Phone:877-378-0401
Practice Address - Fax:949-706-6356
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG795772085R0202X
FLME1193662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherMEDICARE
FL013321800Medicaid