Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 8181 | GA |
NPI | 1104881861 |
---|---|
Provider Name | Dr. Robert M Fryer |
First Address | Atlanta, GA 30342-1703 |
Second Address | Atlanta, GA 30342-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 06/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300022842A | (05) | GA |
850000011 | MEDICARE RAILROAD (01) | GA |
T97588 | (02) | GA |