Provider Demographics
NPI:1952322570
Name:FRY, LIAM MCCOY (MD)
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:MCCOY
Last Name:FRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIAM
Other - Middle Name:MARGARET
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1108 LAVACA ST
Mailing Address - Street 2:SUITE 110-320
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2172
Mailing Address - Country:US
Mailing Address - Phone:512-477-4088
Mailing Address - Fax:512-482-0390
Practice Address - Street 1:1108 LAVACA ST
Practice Address - Street 2:SUITE 110-320
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2172
Practice Address - Country:US
Practice Address - Phone:512-477-4088
Practice Address - Fax:512-482-0390
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3553207R00000X, 207RG0300X
HI13339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00373885OtherMEDICARE RAILROAD
TX192972101Medicaid
TX8W4930OtherBCBS OF TEXAS
TX192972101Medicaid
TX8G5631Medicare PIN