Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | FC088719 | NC |
N | 208600000X | Surgeon | FC088719 | NC |
Y | 208200000X | Surgeon | MD452172 | PA |
Y | 208600000X | Surgeon | MD452172 | PA |
N | 2086S0102X | Surgical Critical Care | ME111238 | FL |
NPI | 1013185511 |
---|---|
Provider Name | Fitzgerald Junior Casimir |
First Address | Danville, PA 17822-4903 |
Second Address | Scranton, PA 18510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2008 |
Last Update Date | 25/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004154000 | (05) | FL |