Provider Demographics
NPI:1558362756
Name:FITZGERALD, RALPH JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:JOHN
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8429
Mailing Address - Country:US
Mailing Address - Phone:972-420-1475
Mailing Address - Fax:469-671-5437
Practice Address - Street 1:2560 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 195
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1554
Practice Address - Country:US
Practice Address - Phone:972-420-1475
Practice Address - Fax:469-671-5437
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0841208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039538602Medicaid
TX81M644OtherBCBS
TX81M644OtherBCBS