Provider Demographics
NPI:1932436599
Name:KREITZER, MATTHEW G (DOM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:KREITZER
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 YORKTOWN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5046
Mailing Address - Country:US
Mailing Address - Phone:505-702-7675
Mailing Address - Fax:
Practice Address - Street 1:3500 COMANCHE RD NE
Practice Address - Street 2:BUILDING E, SUITE 13
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4546
Practice Address - Country:US
Practice Address - Phone:505-702-7675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1008171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist