Provider Demographics
NPI:1790287738
Name:FRITZE, BRYAN M
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:M
Last Name:FRITZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ANDERSON STREET
Mailing Address - Street 2:
Mailing Address - City:ALAKANUK
Mailing Address - State:AK
Mailing Address - Zip Code:99554
Mailing Address - Country:US
Mailing Address - Phone:907-238-3151
Mailing Address - Fax:907-238-2706
Practice Address - Street 1:101 ANDERSON STREET
Practice Address - Street 2:
Practice Address - City:ALAKANUK
Practice Address - State:AK
Practice Address - Zip Code:99554
Practice Address - Country:US
Practice Address - Phone:907-238-3151
Practice Address - Fax:907-238-2706
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker