Provider Demographics
NPI:1952925448
Name:FITZPATRICK, JOHN KEVIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEVIN
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2817 ROCK MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7301
Mailing Address - Country:US
Mailing Address - Phone:910-907-8246
Mailing Address - Fax:910-907-6870
Practice Address - Street 1:2817 REILLY RD
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7301
Practice Address - Country:US
Practice Address - Phone:910-907-8246
Practice Address - Fax:910-907-6870
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-03020171000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider