MEDICARE: DEREK A 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	208VP0014X	Interventional Pain Medicine Physician	V9311	TX

General Provider Information

NPI Number	:	1649825290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK A FITZGERALD MD

Provider Business Mailing Address
First Line	:	8522 BROADWAY STE 216
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-6456
Country	:	US
Telephone Number	:	210-874-5260
Fax Number	:	210-864-4838

Provider Business Practice Location Address
First Line	:	805 E 32ND ST STE 100-102
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2537
Country	:	US
Telephone Number	:	210-374-2724
Fax Number	:	210-874-8512

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

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	12/15/2025

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