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General NPI Number Information
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NPI Number | 1790910115
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Entity Type | Organization
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Legal Business Name | THOMAS M FITZPATRICK MD LLC
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Dates
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Enumeration Date | 05/29/2009
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 525 NORTH BARNES
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City | SENECA
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State | OR
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Zip | 97873
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Country | US
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Telephone | 541-542-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 73216 FOLEY RD
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City | BURNS
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State | OR
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Zip | 97720-9303
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Country | US
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Telephone | 541-573-7988
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | THOMAS M FITZPATRICK
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Credential | M.D.
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Telephone | 541-573-7988
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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 | MD16856
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License Number State | OR
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