=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649377508
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON FITZGERALD MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 11/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 541 W. SECOND AVENUE
-----------------------------------------------------
City | TWISP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-422-5700
-----------------------------------------------------
Fax | 509-422-7680
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1340
-----------------------------------------------------
City | OKANOGAN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98840-1340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-689-2525
-----------------------------------------------------
Fax | 509-422-7680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD00029928
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------