Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | G49874 | CA |
NPI | 1245348861 |
---|---|
Provider Name | Dr. Frederick Joseph Kretzschmar |
First Address | Novato, CA 94947 |
Second Address | Greenbrae, CA 94904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 12/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G498740 | (05) | CA |
A51492 | (02) |