Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 17019 | TX |
NPI | 1013292614 |
---|---|
Provider Name | Dr. Glen A Fritz |
First Address | San Antonio, TX 78232-2349 |
Second Address | San Antonio, TX 78232-2349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2011 |
Last Update Date | 14/10/2011 |