Individual
GARY A FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1530 N 7TH ST, SUITE 104, TERRE HAUTE, IN 47807-1057
(812) 234-1344
(812) 232-9480
Mailing address
PO BOX 2505, INDIANAPOLIS, IN 46206-2505
(812) 238-7783
(812) 238-4506
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01029815
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080049937
RR MEDICARE
IN
05
—
100252930
—
IN
Enumeration date
11/03/2005
Last updated
10/18/2010
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