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Individual

JON TODD FITZGERALD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
543 3RD ST, STE C1, LAKE OSWEGO, OR 97034-3067
(503) 636-9656
(503) 636-9657
Mailing address
543 3RD ST, STE C1, LAKE OSWEGO, OR 97034-3067
(503) 636-9656
(503) 636-9657

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DP00248
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
054399002
BLUE CROSS
OR
05
067533
OR
01
3008597-02
HMOO
OR
01
F627
HEALTHNET
OR
Enumeration date
08/19/2005
Last updated
12/09/2009
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