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Individual
JACKSON R FITZGERALD
Active
Individual
JACKSON R FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
185769-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107007001102
IHC
UT
01
—
212704
DESERET MUTUAL
UT
01
—
32664
PEHP
UT
01
—
52944
HEALTHY U
UT
01
—
870525882FI1
EDUCATORS MUTUAL
UT
01
—
PR00525
MOLINA
UT
01
—
QM0000076595
ALTIUS
UT
Enumeration date
09/13/2006
Last updated
07/08/2007
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