Individual
MR. STEVEN PALMER FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
400 FAIRVIEW AVE STE 50, OUTPATIENT SURGICAL CENTER, PONCA CITY, OK 74601-1910
(580) 765-0673
(580) 765-0673
Mailing address
PO BOX 2538, PONCA CITY, OK 74602-2538
(580) 765-0673
(580) 765-0673
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
R0033651
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44442083003
BCBS OKLAHOMA
OK
01
—
P00287646
RR MEDICARE
OK
Enumeration date
07/14/2006
Last updated
10/31/2007
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