Provider Demographics
NPI:1003178989
Name:SEGRO, KIMBERLY FRYER (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FRYER
Last Name:SEGRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-4501
Mailing Address - Country:US
Mailing Address - Phone:864-608-4099
Mailing Address - Fax:
Practice Address - Street 1:101 AVENUE O SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4333
Practice Address - Country:US
Practice Address - Phone:863-294-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL34895207V00000X
FLME136489207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025057400Medicaid
FLI9VKEOtherBLUE CROSS BLUE SHIELD