Provider Demographics
NPI:1821177890
Name:KRETZER, MARY FRANCES DENNIS (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:FRANCES DENNIS
Last Name:KRETZER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:154 COUNTY ROAD 220
Mailing Address - Street 2:PO BOX 1408
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844-3016
Mailing Address - Country:US
Mailing Address - Phone:325-451-4107
Mailing Address - Fax:325-948-3502
Practice Address - Street 1:1219 PARKER
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844
Practice Address - Country:US
Practice Address - Phone:325-648-2862
Practice Address - Fax:325-648-3871
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ4883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122306703Medicaid
TX122306703Medicaid
F66991Medicare UPIN