1700029196 NPI number — DR. DAVID CHRISTOPHER TIETZE M.D.

Table of content: HEIDI STURGILL PA-C (NPI 1679023097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700029196 NPI number — DR. DAVID CHRISTOPHER TIETZE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIETZE
Provider First Name:
DAVID
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700029196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9301 N CENTRAL EXPY STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75231-0805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-220-2468
Provider Business Mailing Address Fax Number:
214-645-3323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9301 N CENTRAL EXPY STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231-0805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-220-2468
Provider Business Practice Location Address Fax Number:
214-645-3323
Provider Enumeration Date:
04/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RS0010X , with the licence number:  N9971 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: N9971 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 310248YL7B . This is a "MEDICARE DALLAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 327943202 . This is a "MEDICAID DALLAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 310248YNGS . This is a "MEDICARE TARRANT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 327943203 . This is a "MEDICAID OTHER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 310248YL7A . This is a "MEDICARE OTHER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 327943204 . This is a "MEDICAID TARRANT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com