Provider Demographics
NPI:1184667545
Name:FITZGERALD, ANDREW SCOTT (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:SCOTT
Last Name:FITZGERALD
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 1:801 E CAMPBELL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-6797
Mailing Address - Country:US
Mailing Address - Phone:214-766-7282
Mailing Address - Fax:
Practice Address - Street 1:5601 WARREN PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4069
Practice Address - Country:US
Practice Address - Phone:214-377-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046080003Medicaid
TX046080001Medicaid
TX87M602Medicare PIN
TXF57234Medicare UPIN
TX046080001Medicaid