Provider Demographics
NPI:1780639468
Name:FRITZ, TRACY A (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:FRITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6732 MALL DRIVE
Mailing Address - Street 2:PO BOX 317
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016
Mailing Address - Country:US
Mailing Address - Phone:636-748-2434
Mailing Address - Fax:833-643-1219
Practice Address - Street 1:6732 MALL DRIVE
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:MO
Practice Address - Zip Code:63016
Practice Address - Country:US
Practice Address - Phone:636-748-2434
Practice Address - Fax:833-643-1219
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018666207Q00000X
MA216491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN