Provider Demographics
NPI:1053396523
Name:PELZ, FREDERICK R (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:R
Last Name:PELZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7205 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1758
Practice Address - Country:US
Practice Address - Phone:901-684-1322
Practice Address - Fax:901-682-6368
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD012323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA96790Medicare UPIN