Provider Demographics
NPI:1760579742
Name:WILLIAM H. FITZPATRICK, DPM PC
Entity Type:Organization
Organization Name:WILLIAM H. FITZPATRICK, DPM PC
Other - Org Name:WM H FITZPATRICK, DPM
Other - Org Type:Other Name
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-299-4487
Mailing Address - Street 1:7700 MENAUL BLVD NE STE D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4639
Mailing Address - Country:US
Mailing Address - Phone:505-299-4487
Mailing Address - Fax:505-299-4498
Practice Address - Street 1:7700 MENAUL BLVD NE STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4639
Practice Address - Country:US
Practice Address - Phone:505-299-4487
Practice Address - Fax:505-299-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM086213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00053116Medicaid
NM0739160001Medicare NSC
NMNMB2014Medicare PIN