Healthcare Provider Details

I. General information

NPI: 1710479530
Provider Name (Legal Business Name): HERBERT A FRITSCHE JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12117 BEE CAVES ROAD BUILDING 3 SUITE 100
AUSTIN TX
78738
US

IV. Provider business mailing address

12117 BEE CAVES ROAD BUILDING 3 SUITE 100
AUSTIN TX
78738
US

V. Phone/Fax

Practice location:
  • Phone: 512-519-0400
  • Fax: 512-439-2038
Mailing address:
  • Phone: 512-519-0400
  • Fax: 512-439-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: