MEDICARE: MR. PATRICK M FITZWATER PA-C

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	363AM0700X	Medical Physician Assistant	PA 02759	TX

General Provider Information

NPI Number	:	1154509602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK M FITZWATER PA-C

Provider Business Mailing Address
First Line	:	1615 HILLENDAHL BLVD
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77055-3402
Country	:	US
Telephone Number	:	713-462-6565
Fax Number	:	713-462-6581

Provider Business Practice Location Address
First Line	:	1615 HILLENDAHL BLVD
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77055-3402
Country	:	US
Telephone Number	:	713-462-6565
Fax Number	:	713-462-6581

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	01/03/2014

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