Basic Information
| Provider Information | |||||||||
| NPI: | 1629011424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITZPATRICK | ||||||||
| FirstName: | CLAYTON | ||||||||
| MiddleName: | BRENNAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4199 GATEWAY BLVD | ||||||||
| Address2: | SUITE 3100 | ||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476308940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128424550 | ||||||||
| FaxNumber: | 8128424549 | ||||||||
| Practice Location | |||||||||
| Address1: | 4199 GATEWAY BLVD. | ||||||||
| Address2: | SUITE 3100 | ||||||||
| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128424550 | ||||||||
| FaxNumber: | 8128424549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 09/09/2019 | ||||||||
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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 | 207VM0101X | 2005-00676 | NC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VM0101X | 01056421A | IN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200921290 | 05 | IN | MEDICAID | 5901314 | 05 | NC | MEDICAID |