Provider Demographics
NPI:1841050481
Name:FRITZ, JACKSON MAX
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:MAX
Last Name:FRITZ
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 1:901 SMITH DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2368
Mailing Address - Country:US
Mailing Address - Phone:301-640-6375
Mailing Address - Fax:
Practice Address - Street 1:901 SMITH DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2368
Practice Address - Country:US
Practice Address - Phone:301-640-6375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program