Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | DO1406 | TN |
N | 2081P2900X | Pain Medicine | DO1406 | TN |
NPI | 1124097167 |
---|---|
Provider Name | Dr. Bruce Brian Fry |
First Address | Knoxville, TN 37922-3355 |
Second Address | Knoxville, TN 37922-3355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 20/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2340066 | UNITED HEALTH CARE (01) | TN |
250014223 | RAILROAD MEDICARE (01) | TN |
3306949 | (05) | TN |
4028311 | BLUE CROSS BLUE SHIELD (01) | TN |
H52379 | (02) | |
TN01A9 | JOHN DEERE HEALTHCARE (01) | TN |
TN01B1 | JOHN DEERE HEALTHCARE (01) | TN |