Basic Information
| Provider Information | |||||||||
| NPI: | 1649632415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRYOUX | ||||||||
| FirstName: | ELIZABETH AMES | ||||||||
| MiddleName: | MEYER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 626 CHICKASAW AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392065807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183482096 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019845601 | ||||||||
| FaxNumber: | 6014968157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2016 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RB0002X | 25895 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Bariatric Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 25895 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.