MEDICARE: MR. JOSEPH P FRITSCH PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	407	OK

General Provider Information

NPI Number	:	1427062082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH P FRITSCH PHD

Provider Business Mailing Address
First Line	:	1717B S UTICA AVE
Second Line	:	SUITE 200
City	:	TULSA
State	:	OK
Zip	:	74104-5333
Country	:	US
Telephone Number	:	918-712-7900
Fax Number	:	918-712-9757

Provider Business Practice Location Address
First Line	:	1717B S UTICA AVE
Second Line	:	SUITE 200
City	:	TULSA
State	:	OK
Zip	:	74104-5333
Country	:	US
Telephone Number	:	918-712-7900
Fax Number	:	918-712-9757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	11/24/2010

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