Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 14277 | SC |
NPI | 1104873017 |
---|---|
Provider Name | Terry L Fry |
First Address | Georgetown, SC 29440-2410 |
Second Address | Georgetown, SC 29440-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 13/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
142777 | (05) | SC |
C88015 | (02) | SC |