MEDICARE: DR. JERE JONATHAN FITTS M.D.

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	ME26912	FL

General Provider Information

NPI Number	:	1639223068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERE JONATHAN FITTS M.D.

Provider Business Mailing Address
First Line	:	801 CLEMATIS ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5106
Country	:	US
Telephone Number	:	561-655-5155
Fax Number	:	561-659-3619

Provider Business Practice Location Address
First Line	:	801 CLEMATIS ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5106
Country	:	US
Telephone Number	:	561-655-5155
Fax Number	:	561-659-3619

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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