Provider Demographics
NPI:1831257377
Name:FRY, NORMAN D (MD)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:D
Last Name:FRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1002 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-2810
Mailing Address - Country:US
Mailing Address - Phone:432-582-2285
Mailing Address - Fax:432-582-2107
Practice Address - Street 1:1002 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-2810
Practice Address - Country:US
Practice Address - Phone:432-582-2285
Practice Address - Fax:432-582-2107
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1421207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22795Medicare UPIN