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NPI Code Detail

MEDICARE: DR. TIMOTHY FITZGERALD DO

MEDICARE: DR. TIMOTHY FITZGERALD DO
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
1207Q00000XFamily Medicine Physician0320000477VT
2208D00000XGeneral Practice Physician2471AZ

Other Identifiers

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

General Provider Information

NPI Number : 1811964836
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY FITZGERALD DO
Provider Business Mailing Address
First Line : PO BOX 188
Second Line :
City : MARANA
State : AZ
Zip : 85653-0188
Country : US
Telephone Number : 520-682-4111
Fax Number : 520-818-3630
Provider Business Practice Location Address
First Line : 13395 N MARANA MAIN ST
Second Line :
City : MARANA
State : AZ
Zip : 85653-7008
Country : US
Telephone Number : 520-682-4111
Fax Number : 520-818-3630
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 08/24/2016

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Directions to “ DR. TIMOTHY FITZGERALD DO” Practice Location

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