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General NPI Number Information
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NPI Number | 1578513941
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Entity Type | Individual
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Provider Name | JOHN BRADLEY FITZWATER M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 1015 E 32ND ST SUITE 306
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City | AUSTIN
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State | TX
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Zip | 78705-2707
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Country | US
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Telephone | 512-459-1200
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Fax | 512-459-0404
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Provider Business Mailing Address
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Address Line | 12221 MOPAC EXPRESSWAY NORTH
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City | AUSTIN
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State | TX
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Zip | 78758-0000
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Country | US
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Telephone | 512-901-2533
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Fax | 512-459-0404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | L0174
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License Number State | TX
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