MEDICARE: ANNE A FITZPATRICK

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	207Q00000X	Family Medicine Physician	82-190	NM

General Provider Information

NPI Number	:	1659344729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE A FITZPATRICK

Provider Business Mailing Address
First Line	:	2001 CENTRO FAMILIAR BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4592
Country	:	US
Telephone Number	:	505-873-7462
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 CENTRO FAMILIAR BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4592
Country	:	US
Telephone Number	:	505-873-7462
Fax Number	:

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	07/08/2007

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Directions to “ ANNE A FITZPATRICK ” Practice Location

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