Provider Demographics
NPI:1154396133
Name:FIETZ, MARY JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JEAN
Last Name:FIETZ
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 1:1255 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1210
Mailing Address - Country:US
Mailing Address - Phone:602-685-5211
Mailing Address - Fax:602-685-5325
Practice Address - Street 1:1255 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1210
Practice Address - Country:US
Practice Address - Phone:602-685-5211
Practice Address - Fax:602-685-5028
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20108207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0182900OtherBCBSAZ-PATH ASSOC
AZAZ0828930OtherBCBSAZ-SUN CITY PATH
AZAX4478OtherHEALTH NET AZ-PATH ASSOC
AZ111287Medicaid
AZ1Z7112OtherHEALTH NET AZ-SUN CITY PA
AZAX4478OtherHEALTH NET AZ-PATH ASSOC
AZ1Z7112OtherHEALTH NET AZ-SUN CITY PA
AZ111287Medicaid
AZ220024020Medicare PIN
AZZ22WCGNG1KMedicare PIN