Healthcare Provider Details

I. General information

NPI: 1902852692
Provider Name (Legal Business Name): FREDERICK N GOERTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 E 32ND ST
AUSTIN TX
78705-2703
US

IV. Provider business mailing address

1406 GORHAM ST
AUSTIN TX
78758-3726
US

V. Phone/Fax

Practice location:
  • Phone: 512-476-7111
  • Fax:
Mailing address:
  • Phone: 512-569-1758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM3236
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberM3236
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: