Provider Demographics
NPI:1750330825
Name:CREUTZMANN, FREDRICK H (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:H
Last Name:CREUTZMANN
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 1:4323 N. JOSEY LN
Mailing Address - Street 2:#203
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4619
Mailing Address - Country:US
Mailing Address - Phone:972-394-7277
Mailing Address - Fax:972-394-4800
Practice Address - Street 1:4323 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4619
Practice Address - Country:US
Practice Address - Phone:972-394-7277
Practice Address - Fax:972-394-4800
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4940207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A03QOtherBLUE CROSS BLUE SHEILD
TX10014284Medicaid
TX00A030QMedicare ID - Type Unspecified
TXC14881Medicare UPIN