Basic Information
| Provider Information | |||||||||
| NPI: | 1356339584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRITSCH | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7900 FANNIN ST | ||||||||
| Address2: | SUITE 2300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137901349 | ||||||||
| FaxNumber: | 7137900028 | ||||||||
| Practice Location | |||||||||
| Address1: | 7900 FANNIN ST | ||||||||
| Address2: | SUITE 2300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137901349 | ||||||||
| FaxNumber: | 7137900028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 05/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 036388 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 088589901 | 05 | TX | MEDICAID | 80354C | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |