Provider Demographics
NPI:1508050196
Name:FITZGERALD, GERALD J (DO)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:J
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12464 INDIAN ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3005
Mailing Address - Country:US
Mailing Address - Phone:727-596-1815
Mailing Address - Fax:727-593-0002
Practice Address - Street 1:12464 INDIAN ROCKS RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3005
Practice Address - Country:US
Practice Address - Phone:727-596-1815
Practice Address - Fax:727-593-0002
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0105649OtherUNITED
FL5778427OtherAETNA
FL811456OtherFIRST
FL57246OtherBCBS
FL080124319OtherRAILROAD MEDICARE
FL811456OtherFIRST
FLG22536Medicare UPIN