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Individual

PAUL FRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1520 VIRGINIA RANCH ROAD, SUITE 101B, GARDNERVILLE, NV 89410-5731
(775) 782-2442
(775) 782-7205
Mailing address
973 MICA DR, SUITE 201, CARSON CITY, NV 89705-7255
(775) 783-6190
(775) 783-6191

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
6420
NV
207X00000X
Orthopaedic Surgery Physician
G54590
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002003052
NV
01
00G545900
MEDI-CAL
CA
01
200034256
MEDICARE RAILROAD
CA
01
CC6619
BCBS
NV
01
P00343660
MEDICARE RAILROAD
NV
Enumeration date
11/03/2005
Last updated
07/20/2021
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