# DOUGLAS FITZWATER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Caruthersville Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467442566
- **Authorized official:** DOUGLAS S FITZWATER MD (MD OWNER)
- **Authorized official phone:** (573) 333-0033

## Contact information

- **Practice address:** 412 WARD AVE, CARUTHERSVILLE, MO 63830-1451
- **Practice address phone:** (573) 333-0033
- **Practice address fax:** (573) 333-2522
- **Mailing address:** PO BOX 817, CAPE GIRARDEAU, MO 63702-0817
- **Mailing address phone:** (573) 335-4715
- **Mailing address fax:** (573) 334-2303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 10/28/2005
- **Last updated:** 02/12/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 596113605 | — | MO |
| 01 | — | 7158 | BCBS | MO |