Healthcare Provider Details

I. General information

NPI: 1245263110
Provider Name (Legal Business Name): KEVIN R FITZGERALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 29 1/2 RD
GRAND JUNCTION CO
81504-5383
US

IV. Provider business mailing address

510 29 1/2 RD
GRAND JUNCTION CO
81504-5383
US

V. Phone/Fax

Practice location:
  • Phone: 970-248-6900
  • Fax:
Mailing address:
  • Phone: 970-248-6984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30381
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: