Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | LL34895 | SC |
Y | 207V00000X | Obstetrician & Gynecologist | ME136489 | FL |
NPI | 1003178989 |
---|---|
Provider Name | Kimberly E Fryer |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606-3603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2012 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025057400 | (05) | FL |
I9VKE | BLUE CROSS BLUE SHIELD (01) | FL |