=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215340781
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRAXTON FRITZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2014
-----------------------------------------------------
Last Update Date | 07/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11820 BANDERA RD STE 102
-----------------------------------------------------
City | HELOTES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78023-4637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-477-7180
-----------------------------------------------------
Fax | 210-736-7072
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2961 MOSSROCK
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-5119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-731-4800
-----------------------------------------------------
Fax | 210-731-4810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 01081892A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 36970
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | U8632
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------