1508948001 NPI number — MR. DAVID BRUCE FRETZ IDC 8425

Table of content: MR. DAVID BRUCE FRETZ IDC 8425 (NPI 1508948001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508948001 NPI number — MR. DAVID BRUCE FRETZ IDC 8425

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRETZ
Provider First Name:
DAVID
Provider Middle Name:
BRUCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IDC 8425
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRETZ
Provider Other First Name:
DAVID
Provider Other Middle Name:
BRUCE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
IDC 8425
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508948001
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 LEYTE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORONADO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92118-3107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-522-0807
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USS MOBILE BAY CG 53
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
US
Provider Business Practice Location Address Postal Code:
AP
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-556-4576
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2006

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: 146D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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