MEDICARE: DR. BRYAN T. FITZGERALD D.O.

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	207P00000X	Emergency Medicine Physician	34-002637	OH

General Provider Information

NPI Number	:	1134210347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN T. FITZGERALD D.O.

Provider Business Mailing Address
First Line	:	5664 STONE LAKE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-6001
Country	:	US
Telephone Number	:	937-435-7445
Fax Number	:	937-433-7475

Provider Business Practice Location Address
First Line	:	5664 STONE LAKE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-6001
Country	:	US
Telephone Number	:	937-435-7445
Fax Number	:	937-433-7475

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/30/2014

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