Provider Demographics
NPI:1255814281
Name:ROBERT WE FRY MD INC.
Entity type:Organization
Organization Name:ROBERT WE FRY MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:GABRIELLE
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-434-4848
Mailing Address - Street 1:1111 LAS TABLAS RD STE R
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9732
Mailing Address - Country:US
Mailing Address - Phone:805-434-4848
Mailing Address - Fax:805-434-0662
Practice Address - Street 1:1111 LAS TABLAS RD STE R
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9732
Practice Address - Country:US
Practice Address - Phone:805-434-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFF2487507OtherDEA NUMBER