MEDICARE: DR. STEPHEN FITZGERALD MD

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	207RG0100X	Gastroenterology Physician	ME82755	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	100015137	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2792011	OTHER	FL	AETNA
2	4871364003	OTHER	FL	CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	41350290	OTHER	FL	AETNA
5	03200	OTHER	FL	BLUE CROSS BLUE SHIELD
7	189289	OTHER	FL	WELLCARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558344549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN FITZGERALD MD

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-778-8513
Fax Number	:	615-628-6877

Provider Business Practice Location Address
First Line	:	7765 144TH ST
Second Line	:	SUITE 6
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3206
Country	:	US
Telephone Number	:	772-589-0580
Fax Number	:	772-589-0760

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	08/11/2016

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Directions to “ DR. STEPHEN FITZGERALD MD” Practice Location

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