Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 57.023726 | OH |
N | 111NI0900X | Internist | 57.023726 | OH |
N | 207RA0401X | Internist - Addiction Medicine | 35.127366 | OH |
NPI | 1144658162 |
---|---|
Provider Name | Isaiah Fry |
First Address | Cincinnati, OH 45236-2725 |
Second Address | Edgewood, KY 41017-3403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2013 |
Last Update Date | 04/02/2022 |