Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 33481 | TX |
N | 213EG0000X | General Practice | 33481 | TX |
Y | 1223P0221X | Pediatric Dentist | 2021 | SC |
NPI | 1013442078 |
---|---|
Provider Name | Jonathan Elliot Fryml |
First Address | Taylors, SC 29687-4008 |
Second Address | Taylors, SC 29687-4008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2017 |
Last Update Date | 03/05/2021 |