Provider Demographics
NPI:1013933456
Name:FITZGIBBONS, STELLA (MD)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:FITZGIBBONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4922
Mailing Address - Country:US
Mailing Address - Phone:713-665-5095
Mailing Address - Fax:
Practice Address - Street 1:4545 POST OAK PLACE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3164
Practice Address - Country:US
Practice Address - Phone:713-960-8008
Practice Address - Fax:713-960-0965
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B22717Medicare UPIN
TX8670B8Medicare PIN
TXTXB100471Medicare PIN