MEDICARE: DR. FREDRICK H CREUTZMANN M.D.

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	207V00000X	Obstetrics & Gynecology Physician	G4940	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A03Q	OTHER	TX	BLUE CROSS BLUE SHEILD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750330825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDRICK H CREUTZMANN M.D.

Provider Business Mailing Address
First Line	:	4323 N. JOSEY LN
Second Line	:	#203
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4619
Country	:	US
Telephone Number	:	972-394-7277
Fax Number	:	972-394-4800

Provider Business Practice Location Address
First Line	:	4323 N JOSEY LN
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4619
Country	:	US
Telephone Number	:	972-394-7277
Fax Number	:	972-394-4800

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	07/09/2007

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