Individual
LARRY L FITZWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
#1 HEALTHCARE DRIVE, PHILIPPI, WV 26416
(304) 457-1760
(304) 457-1516
Mailing address
#1 HEALTHCARE DRIVE, PHILIPPI, WV 26416
(304) 457-1760
(304) 457-1516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
318
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
318
LICENSE
WV
Enumeration date
01/08/2007
Last updated
07/08/2007
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