Provider Demographics
NPI:1861450322
Name:FITZPATRICK, TIMOTHY SEAN (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SEAN
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 1:6300 LA CALMA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3843
Mailing Address - Country:US
Mailing Address - Phone:888-800-8237
Mailing Address - Fax:
Practice Address - Street 1:6300 LA CALMA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3843
Practice Address - Country:US
Practice Address - Phone:888-800-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8056207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170937002Medicaid
TX170937005Medicaid
TX8D8120Medicare PIN
TXP00132458Medicare PIN
TXP00244612Medicare PIN
TX8G5719Medicare PIN
TXI04278Medicare UPIN
TX170937005Medicaid
TX8B5336Medicare PIN