Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD60734111 | WA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD60734111 | WA |
NPI | 1205125945 |
---|---|
Provider Name | Judd R Fitzgerald |
First Address | Kennewick, WA 99336-2623 |
Second Address | Kennewick, WA 99336-2623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 16/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2077644 | (05) | WA |