Provider Demographics
NPI:1417013319
Name:FITTER, JEFFREY C (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:FITTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2375
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70381
Mailing Address - Country:US
Mailing Address - Phone:985-384-7900
Mailing Address - Fax:985-384-8049
Practice Address - Street 1:1234 DAVID DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380
Practice Address - Country:US
Practice Address - Phone:985-384-7900
Practice Address - Fax:985-384-8049
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.04053R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1175731Medicaid
B63232Medicare UPIN
51641Medicare ID - Type Unspecified