Provider Demographics
NPI:1700440930
Name:FITZPATRICK, JOHN CAREY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CAREY
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1512 W 35TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1437
Mailing Address - Country:US
Mailing Address - Phone:512-451-0103
Mailing Address - Fax:512-451-2741
Practice Address - Street 1:801 W 38TH ST STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1169
Practice Address - Country:US
Practice Address - Phone:512-451-0103
Practice Address - Fax:512-451-2741
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPENDING207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program