Provider Demographics
NPI:1801910658
Name:FRYBARGER, JAMES ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:FRYBARGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 HIGHLAND CROSS DR
Mailing Address - Street 2:STE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1733
Mailing Address - Country:US
Mailing Address - Phone:281-784-1500
Mailing Address - Fax:281-784-1522
Practice Address - Street 1:211 HIGHLAND CROSS DR
Practice Address - Street 2:STE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1733
Practice Address - Country:US
Practice Address - Phone:281-784-1500
Practice Address - Fax:281-784-1522
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086580390200000X
TXP1303207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285948001Medicaid
TX8CZ655OtherBCBS-TX
1801910658OtherTRICARE SOUTH
TXTXB140178Medicare PIN
TX285948001Medicaid