Provider Demographics
NPI:1861562407
Name:FRITZ, JEFFERY M (MD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:M
Last Name:FRITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 PRESTON RD UNIT 110648
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5237
Mailing Address - Country:US
Mailing Address - Phone:512-422-0633
Mailing Address - Fax:
Practice Address - Street 1:7901 JOHN W CARPENTER FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4832
Practice Address - Country:US
Practice Address - Phone:972-382-9992
Practice Address - Fax:469-802-0070
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL10482086S0129X, 208VP0014X, 208D00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141115902Medicaid
8F4041OtherBC
8F4041OtherBC
TX141115902Medicaid