Provider Demographics
NPI:1033286349
Name:FRITZ, HARVEY RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:RICHARD
Last Name:FRITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-0400
Mailing Address - Country:US
Mailing Address - Phone:509-750-8989
Mailing Address - Fax:509-750-8989
Practice Address - Street 1:315 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1254
Practice Address - Country:US
Practice Address - Phone:509-750-8989
Practice Address - Fax:509-750-8989
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001101207P00000X
ORDO20983207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0160916OtherL & I
WA0160916OtherL & I
AB06888Medicare ID - Type Unspecified