Provider Demographics
NPI:1669621785
Name:FRYE, BRANDON DANIEL (DO)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:DANIEL
Last Name:FRYE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 W EAU GALLIE BLVD
Mailing Address - Street 2:UNIT 104
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4033
Mailing Address - Country:US
Mailing Address - Phone:321-500-4263
Mailing Address - Fax:888-782-9622
Practice Address - Street 1:2010 W EAU GALLIE BLVD
Practice Address - Street 2:UNIT 104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4033
Practice Address - Country:US
Practice Address - Phone:321-500-4263
Practice Address - Fax:888-782-9622
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13191207X00000X, 207XS0106X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN
FLIH213ZMedicare PIN