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General NPI Number Information
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NPI Number | 1144635426
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Entity Type | Organization
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Legal Business Name | GEORGE P. FITZGERALD III MD
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 06/25/2014
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Provider Practice Location Address
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Address Line | 3594 BROADWAY SUITE E
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City | FORT MYERS
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State | FL
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Zip | 33901-8016
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Country | US
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Telephone | 239-334-8888
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Fax | 239-334-9534
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Provider Business Mailing Address
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Address Line | 3594 BROADWAY AVENUE SUITE E
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City | FORT MYERS
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State | FL
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Zip | 33901-8017
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Country | US
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Telephone | 239-334-8888
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Fax | 239-334-9534
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JERI ANN KSIAZEK
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Credential |
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Telephone | 239-334-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 0020292
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License Number State | FL
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