Provider Demographics
NPI:1508862871
Name:FRITZLER, MARK DOUGLAS (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DOUGLAS
Last Name:FRITZLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:645 W EAST AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7201
Mailing Address - Country:US
Mailing Address - Phone:530-898-8405
Mailing Address - Fax:530-899-0944
Practice Address - Street 1:645 W EAST AVE
Practice Address - Street 2:STE 1
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-7201
Practice Address - Country:US
Practice Address - Phone:530-898-8405
Practice Address - Fax:530-899-0944
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG60227208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G602270Medicaid
CA00G602270Medicare ID - Type Unspecified
CA00G602270Medicaid
CA1200250001Medicare NSC