Provider Demographics
NPI:1598848335
Name:FRITZ, SAMUEL DELBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DELBERT
Last Name:FRITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 GERI LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2306
Mailing Address - Country:US
Mailing Address - Phone:859-623-0984
Mailing Address - Fax:859-623-0984
Practice Address - Street 1:318 GERI LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2306
Practice Address - Country:US
Practice Address - Phone:859-623-0984
Practice Address - Fax:859-623-0984
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15497208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000045724OtherBCBS
KY64154974Medicaid
KYC69434Medicare UPIN
KY1085401Medicare PIN