Healthcare Provider Details

I. General information

NPI: 1427062082
Provider Name (Legal Business Name): JOSEPH P FRITSCH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717B S UTICA AVE SUITE 200
TULSA OK
74104-5333
US

IV. Provider business mailing address

1717B S UTICA AVE SUITE 200
TULSA OK
74104-5333
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-7900
  • Fax: 918-712-9757
Mailing address:
  • Phone: 918-712-7900
  • Fax: 918-712-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number407
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: