Provider Demographics
NPI:1417155383
Name:FITZPATRICK, COLLEEN M (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 S GRAND BLVD
Mailing Address - Street 2:PEDIATRIC SURGERY
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-577-5629
Mailing Address - Fax:314-268-6454
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:PEDIATRIC SURGERY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-577-5629
Practice Address - Fax:314-268-6454
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120235032086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery