Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC7846 | TX |
NPI | 1639242795 |
---|---|
Provider Name | Brett Fryar |
First Address | Lubbock, TX 79423-2229 |
Second Address | Lubbock, TX 79423-2229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U70685 | (02) | TX |