Individual
DR. EDWARD KENT FRYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036081908
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03081908
—
IL
01
—
4600208
BLUE CROSS BLUE SHIELD
IL
01
—
IL1789
MEDICARE GROUP PTAN
IL
01
—
IL1789002
MEDICARE PTAN
IL
Enumeration date
11/02/2005
Last updated
08/30/2011
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