MEDICARE: DR. THOMAS J FITZGERALD MD PH 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	207RH0003X	Hematology & Oncology Physician	30401	TN
2	207RH0003X	Hematology & Oncology Physician	ME85034	FL
3	207RH0003X	Hematology & Oncology Physician	22612	AL
4	207RH0003X	Hematology & Oncology Physician	MD181320	OR
5	207RH0003X	Hematology & Oncology Physician	MD60418114	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	13519Y	OTHER	FL	MEDICARE PTAN
3	102I908108	OTHER	AL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336134766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J FITZGERALD MD PH D

Provider Business Mailing Address
First Line	:	PO BOX 850
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-0146
Country	:	US
Telephone Number	:	360-683-9895
Fax Number	:	360-582-5614

Provider Business Practice Location Address
First Line	:	844 N 5TH AVE
Second Line	:
City	:	SEQUIM
State	:	WA
Zip	:	98382-3045
Country	:	US
Telephone Number	:	360-683-9895
Fax Number	:	360-582-5614

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	04/26/2025

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Directions to “ DR. THOMAS J FITZGERALD MD PH D” Practice Location

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