Individual
MR. JACK ROBERT FRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
7333 SMITHS MILL RD, NEW ALBANY, OH 43054-9291
(614) 775-6675
Mailing address
963 NEIL AVE, COLUMBUS, OH 43201-3434
(614) 299-0902
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN161169
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2044719
—
OH
Enumeration date
07/26/2006
Last updated
07/08/2007
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