1366674590 NPI number — JULIA N FITZER AA

Table of content: JULIA N FITZER AA (NPI 1366674590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366674590 NPI number — JULIA N FITZER AA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZER
Provider First Name:
JULIA
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODI
Provider Other First Name:
JULIA
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366674590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63126-0407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-386-7222
Provider Business Mailing Address Fax Number:
636-200-4036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10010 KENNERLY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-386-7222
Provider Business Practice Location Address Fax Number:
636-200-4036
Provider Enumeration Date:
08/21/2009

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: 367H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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