Provider Demographics
NPI:1932169653
Name:FITZGERALD, DAVID J (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5154
Mailing Address - Country:US
Mailing Address - Phone:970-392-2026
Mailing Address - Fax:970-392-2028
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5154
Practice Address - Country:US
Practice Address - Phone:970-392-2026
Practice Address - Fax:970-392-2028
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46122207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100282300DMedicaid
OK100196190BMedicaid
CO63528258Medicaid
KS055790OtherBCBS OF KANSAS
KS110186732Medicare ID - Type UnspecifiedPALMETTO GBA RAILROAD
OK248432702Medicare ID - Type Unspecified
COCOA102822Medicare PIN
OK100196190BMedicaid
CO63528258Medicaid
COC810778Medicare PIN