FRITZ, RUSSELL C (MD)

Provider Demographics

• NPI: 1679550032
• Name: FRITZ, RUSSELL C (MD)
• Entity Type: Individual
• Prefix: DR
• First Name: RUSSELL
• Middle Name: C
• Last Name: FRITZ
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: PO BOX 6102
• Mailing Address - City: NOVATO
• Mailing Address - State: CA
• Mailing Address - Zip Code: 94948-6102
• Mailing Address - Country: US
• Practice Address - Street 1: 250 BON AIR RD
• Practice Address - City: GREENBRAE
• Practice Address - State: CA
• Practice Address - Zip Code: 94904-1702
• Practice Address - Country: US
• Practice Address - Phone: 415-884-3415
• Practice Address - Fax: 415-883-0877
• Is Sole Proprietor?: No
• Enumeration Date: 2005-12-28
• Last Update Date: 2020-05-13

Provider Licenses

State	License ID	Taxonomies
AK	4953	2085R0202X
CO	31740	2085R0202X
IL	36103737	2085R0202X
MT	56	2085R0202X
NV	9663	2085R0202X
NJ	MA71752	2085R0202X
NY	214699-1	2085R0202X
OH	35-06-3882-F	2085R0202X
OK	21396	2085R0202X
TX	J5764	2085R0202X
WA	MD00032517	2085R0202X
AZ	28798	2085U0001X
CA	G60870	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology
No	2085U0001X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Ultrasound

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OK	00G60870	Medicaid
CA	300035761	Other	RAILROAD MEDICARE
CA	00G608700	Medicaid
CO	1317403	Medicaid
AZ	867666	Medicaid
NJ	8563403	Medicaid
WA	8169633	Medicaid
CA	300121784	Other	RAILROAD MEDICARE
CA	00G608700	Medicaid
CO	1317403	Medicaid
NE	281992	Medicare PIN
CO	CO300483	Medicare PIN
CA	BY139P	Medicare PIN
CA	300035761	Other	RAILROAD MEDICARE
NJ	051244	Medicare PIN
HI	CX391Z	Medicare PIN
CA	BY139V	Medicare PIN
CA	00G6087022	Medicare PIN
OK	00G60870	Medicaid
AZ	867666	Medicaid
CA	00G6087012	Medicare PIN
CA	BY139O	Medicare PIN
CA	BY139T	Medicare PIN
CA	00G6087023	Medicare PIN
CA	BY139S	Medicare PIN
CA	00G6087019	Medicare PIN
CA	00G6087015	Medicare PIN
CA	00G608709	Medicare PIN
HI	CX391Z	Medicare PIN
CA	00G608709	Medicare PIN
CA	300035761	Other	RAILROAD MEDICARE
CA	E89774	Medicare UPIN
AZ	867666	Medicaid
OK	00G60870	Medicaid
WA	AB07762	Medicare PIN
CA	00G6087011	Medicare PIN
CA	BY139T	Medicare PIN
NV	V105278	Medicare PIN
CA	00G6087013	Medicare PIN