MEDICARE: DR. KEVIN R FITZGERALD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	30381	CO

General Provider Information

NPI Number	:	1245263110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN R FITZGERALD M.D.

Provider Business Mailing Address
First Line	:	510 29 1/2 RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-5383
Country	:	US
Telephone Number	:	970-248-6984
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 29 1/2 RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-5383
Country	:	US
Telephone Number	:	970-248-6900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/13/2024

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