Individual
FREDRIC TIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
61250 SE COOMBS PL, BEND, OR 97702-3704
(541) 706-5930
(541) 706-5931
Mailing address
PO BOX 6096, BEND, OR 97708-6096
(541) 548-8131
(541) 706-3765
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
G50497
CA
207P00000X
Emergency Medicine Physician
Primary
MD166601
OR
Other
Enumeration date
07/10/2006
Last updated
09/09/2024
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