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Individual

DR. JOHN BRADLEY FITZWATER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1015 E 32ND ST, SUITE 306, AUSTIN, TX 78705-2707
(512) 459-1200
(512) 459-0404
Mailing address
12221 MOPAC EXPRESSWAY NORTH, AUSTIN, TX 78758-0000
(512) 901-2533
(512) 459-0404

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
L0174
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0006MH
BLUE CROSS
TX
01
10035722
AMERIGROUP
TX
05
141250405
TX
05
141250406
TX
01
7269218
AETNA
TX
Enumeration date
05/10/2006
Last updated
07/15/2009
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