MEDICARE: JILL ELIZABETH FITZPATRICK 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	207Q00000X	Family Medicine Physician	00A635230	CA

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

General Provider Information

NPI Number	:	1689640658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL ELIZABETH FITZPATRICK MD

Provider Business Mailing Address
First Line	:	280 SIERRA COLLEGE DR
Second Line	:	SUITE 120
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-5763
Country	:	US
Telephone Number	:	530-477-4480
Fax Number	:	530-477-7755

Provider Business Practice Location Address
First Line	:	280 SIERRA COLLEGE DR
Second Line	:	SUITE 120
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-5763
Country	:	US
Telephone Number	:	530-477-4480
Fax Number	:	530-477-7755

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	12/05/2013

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