Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 22954 | AZ |
NPI | 1134250228 |
---|---|
Provider Name | Dr. Jerry William Fitz |
First Address | Tucson, AZ 85718-4740 |
Second Address | Tucson, AZ 85739-1091 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |