Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 33803 | AZ |
NPI | 1033184700 |
---|---|
Provider Name | Matthew Gretzer |
First Address | Tucson, AZ 85706-7124 |
Second Address | Tucson, AZ 85724-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I13623 | (02) | AZ |
P00236512 | RR MEDICARE (01) | AZ |