Provider Demographics
NPI:1588637557
Name:FITZGERALD, CARY DOYLE (NP)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:DOYLE
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 N TOWN EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4606
Mailing Address - Country:US
Mailing Address - Phone:972-686-1880
Mailing Address - Fax:972-686-5845
Practice Address - Street 1:1280 N TOWN EAST BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4606
Practice Address - Country:US
Practice Address - Phone:972-686-1880
Practice Address - Fax:972-686-5845
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX612371363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C9060Medicare ID - Type Unspecified
TXP93639Medicare UPIN