Provider Demographics
NPI:1558344549
Name:FITZGERALD, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-778-8513
Mailing Address - Fax:615-628-6877
Practice Address - Street 1:7765 144TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3206
Practice Address - Country:US
Practice Address - Phone:772-589-0580
Practice Address - Fax:772-589-0760
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82755207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2792011OtherAETNA
FL4871364003OtherCIGNA
FL261688200Medicaid
FL41350290OtherAETNA
FL03200OtherBLUE CROSS BLUE SHIELD
FL100015137OtherRAILROAD MEDICARE
FL189289OtherWELLCARE
FL189289OtherWELLCARE
FL4871364003OtherCIGNA