Provider Demographics
NPI:1669093191
Name:FITZGERALD, JESSE LEE (DO)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:LEE
Last Name:FITZGERALD
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Gender:M
Credentials:DO
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Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-6807
Mailing Address - Fax:210-916-4530
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-6807
Practice Address - Fax:210-916-4530
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2022-02-14
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Provider Licenses
StateLicense IDTaxonomies
VA0102206917208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice