Provider Demographics
NPI:1487655478
Name:FRITZ, JOHN ALLAN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLAN
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 1:1551 PROFESSIONAL LN
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6972
Mailing Address - Country:US
Mailing Address - Phone:303-776-7582
Mailing Address - Fax:303-776-7583
Practice Address - Street 1:1551 PROFESSIONAL LN
Practice Address - Street 2:SUITE 135
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6972
Practice Address - Country:US
Practice Address - Phone:303-776-7582
Practice Address - Fax:303-776-7583
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COFR03952OtherBLUE CROSS
CO01207505Medicaid
D49816Medicare UPIN
125946005Medicare ID - Type UnspecifiedRAILROAD MEDICARE
COFR03952OtherBLUE CROSS
C3952Medicare PIN