Healthcare Provider Details

I. General information

NPI: 1194992263
Provider Name (Legal Business Name): JOSEPH LEON FITZWATER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 PENNSYLVANIA AVE SUITE 600
FORT WORTH TX
76104-2133
US

IV. Provider business mailing address

1325 PENNSYLVANIA AVE SUITE 600
FORT WORTH TX
76104-2133
US

V. Phone/Fax

Practice location:
  • Phone: 817-878-5298
  • Fax:
Mailing address:
  • Phone: 817-878-5298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number31346
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberN6297
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: