Basic Information
| Provider Information | |||||||||
| NPI: | 1558344549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITZGERALD | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689022 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370689022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157788513 | ||||||||
| FaxNumber: | 6156286877 | ||||||||
| Practice Location | |||||||||
| Address1: | 7765 144TH ST | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | SEBASTIAN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329583206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725890580 | ||||||||
| FaxNumber: | 7725890760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 08/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME82755 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 2792011 | 01 | FL | AETNA | OTHER | 4871364003 | 01 | FL | CIGNA | OTHER | 261688200 | 05 | FL | MEDICAID | 41350290 | 01 | FL | AETNA | OTHER | 03200 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 100015137 | 01 | FL | RAILROAD MEDICARE | OTHER | 189289 | 01 | FL | WELLCARE | OTHER |