Provider Demographics
NPI:1891784542
Name:FRYE, DAVID GORDON (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GORDON
Last Name:FRYE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4300 CASCADE RD SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3631
Mailing Address - Country:US
Mailing Address - Phone:616-243-7900
Mailing Address - Fax:616-243-8299
Practice Address - Street 1:4300 CASCADE RD SE
Practice Address - Street 2:SUITE 103
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3631
Practice Address - Country:US
Practice Address - Phone:616-243-7900
Practice Address - Fax:616-243-8299
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDF007503207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2747523Medicaid
MIDF007503OtherSTATE LICENSE NUMBER
MI2054106025OtherBLUE CROSS BLUE SHIELD
MI2054106025OtherBLUE CROSS BLUE SHIELD
MIDF007503OtherSTATE LICENSE NUMBER