Healthcare Provider Details

I. General information

NPI: 1104949874
Provider Name (Legal Business Name): RYAN FITZGERALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR STE 1100
LITTLE ROCK AR
72205-6333
US

IV. Provider business mailing address

9601 BAPTIST HEALTH DR STE 1100
LITTLE ROCK AR
72205-6333
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-5240
  • Fax: 501-227-9151
Mailing address:
  • Phone: 501-227-5240
  • Fax: 501-227-9151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-5317
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: