Provider Demographics
NPI:1942291372
Name:RITZER, THEODORE F (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:F
Last Name:RITZER
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 1:647 DUNLOP LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5165
Mailing Address - Country:US
Mailing Address - Phone:931-502-3750
Mailing Address - Fax:931-502-3755
Practice Address - Street 1:647 DUNLOP LN
Practice Address - Street 2:STE 101
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5165
Practice Address - Country:US
Practice Address - Phone:931-502-3750
Practice Address - Fax:931-502-3755
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21394207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3060334OtherMEDICARE ID - TYPE UNSPECIFIED
TN3060335Medicaid
TN4185003OtherBLUE CROSS BLUE SHIELD OF TN
TN3060335Medicaid
TN3060334OtherMEDICARE ID - TYPE UNSPECIFIED
TN4185003OtherBLUE CROSS BLUE SHIELD OF TN