Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | MD031915E | PA |
NPI | 1003802364 |
---|---|
Provider Name | Dr. Theresa J Fryer |
First Address | Erie, PA 16508-2558 |
Second Address | Erie, PA 16508-2558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E10414 | (02) | PA |