Provider Demographics
NPI:1558347211
Name:FITZPATRICK, JOHN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:FITZPATRICK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2420 S 73RD ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2396
Mailing Address - Country:US
Mailing Address - Phone:402-397-1654
Mailing Address - Fax:402-397-7926
Practice Address - Street 1:2420 S 73RD ST
Practice Address - Street 2:SUITE 402
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2396
Practice Address - Country:US
Practice Address - Phone:402-397-1654
Practice Address - Fax:402-397-7926
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NE10731207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NED17217Medicare UPIN