Provider Demographics
NPI:1700029196
Name:TIETZE, DAVID CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:TIETZE
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 1:1801 INWOOD RD
Mailing Address - Street 2:WA4.306
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-8883
Mailing Address - Country:US
Mailing Address - Phone:214-645-3304
Mailing Address - Fax:214-645-3323
Practice Address - Street 1:1801 INWOOD RD
Practice Address - Street 2:WA4.306
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8883
Practice Address - Country:US
Practice Address - Phone:214-645-3304
Practice Address - Fax:214-645-3323
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9971207RS0010X, 207XX0005X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX327943204OtherMEDICAID TARRANT
TX310248YNGSOtherMEDICARE TARRANT
TX327943203OtherMEDICAID OTHER
TX310248YL7AOtherMEDICARE OTHER
TX327943202OtherMEDICAID DALLAS
TX310248YL7BOtherMEDICARE DALLAS