Provider Demographics
NPI:1134250228
Name:FITZ, JERRY WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:WILLIAM
Last Name:FITZ
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 1:1000 E VIA ENTRADA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4740
Mailing Address - Country:US
Mailing Address - Phone:520-624-4000
Mailing Address - Fax:520-825-3523
Practice Address - Street 1:39580 S LAGO DEL ORO PKWY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-1091
Practice Address - Country:US
Practice Address - Phone:520-624-4000
Practice Address - Fax:520-825-3523
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22954207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine