Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 10444 | MT |
NPI | 1174546857 |
---|---|
Provider Name | Dr. Carla Catherine Fritz |
First Address | Missoula, MT 59807-7609 |
Second Address | Missoula, MT 59801-7722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 21/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000205699 | (05) | MT |