Provider Demographics
NPI:1629011424
Name:FITZPATRICK, CLAYTON BRENNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:BRENNAN
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 GATEWAY BLVD
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8940
Mailing Address - Country:US
Mailing Address - Phone:812-842-4550
Mailing Address - Fax:812-842-4549
Practice Address - Street 1:4199 GATEWAY BLVD.
Practice Address - Street 2:SUITE 3100
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630
Practice Address - Country:US
Practice Address - Phone:812-842-4550
Practice Address - Fax:812-842-4549
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00676207VM0101X
IN01056421A207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200921290Medicaid
NC5901314Medicaid
IN200921280AMedicaid