Provider Demographics
NPI:1811988496
Name:KRATZ, RICHARD ERIC (MD MPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ERIC
Last Name:KRATZ
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S SANTA ANITA AVE
Mailing Address - Street 2:SUITE P25
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1138
Mailing Address - Country:US
Mailing Address - Phone:626-289-7056
Mailing Address - Fax:626-289-3328
Practice Address - Street 1:207 S SANTA ANITA AVE
Practice Address - Street 2:SUITE P25
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1138
Practice Address - Country:US
Practice Address - Phone:626-289-7056
Practice Address - Fax:626-289-3328
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65340207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G653400OtherBLUE SHIELD
CAG65340Medicaid
G653400OtherBLUE SHIELD
G65340Medicare ID - Type Unspecified