Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME112277 | FL |
N | 2086S0120X | Pediatric Surgery | P1753 | TX |
NPI | 1013144245 |
---|---|
Provider Name | Dr. John W Fitzwater |
First Address | Clearwater, FL 33757-8744 |
Second Address | Tampa, FL 33607-6307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2009 |
Last Update Date | 19/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100963500 | (05) | FL |