Healthcare Provider Details

I. General information

NPI: 1578763314
Provider Name (Legal Business Name): JAMES MASHBURN FITTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 W HIGHWAY 85
DILLEY TX
78017-4601
US

IV. Provider business mailing address

1459 W HWY 45
DILLEY TX
78017-4601
US

V. Phone/Fax

Practice location:
  • Phone: 830-879-3030
  • Fax:
Mailing address:
  • Phone: 830-879-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberH0345
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: