Provider Demographics
NPI:1821170481
Name:FRY, AMY M (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:FRY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1200 SE 28TH ST
Mailing Address - Street 2:2
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3881
Mailing Address - Country:US
Mailing Address - Phone:479-271-0005
Mailing Address - Fax:479-273-1427
Practice Address - Street 1:2900 MEDICAL CENTER PKWY STE 240A
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3204
Practice Address - Country:US
Practice Address - Phone:795-533-3340
Practice Address - Fax:479-553-1964
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-09-16
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Provider Licenses
StateLicense IDTaxonomies
IN01062670207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178153001Medicaid