Individual
MICHAEL FRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
973 MICA DRIVE, SUITE 201, CARSON CITY, NV 89705-7255
(775) 783-6190
(775) 783-6191
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
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
6789
NV
207XS0117X
Orthopaedic Surgery of the Spine Physician
G54589
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002003062
—
NV
05
—
00G545890
—
CA
01
—
200015577
MEDICARE RAILROAD
CA
01
—
CC3027
BCBS
NV
Enumeration date
11/02/2005
Last updated
07/22/2021
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