Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MA45417 | FL |
NPI | 1033498407 |
---|---|
Provider Name | Mr. Colin W Fitzgerald |
First Address | Tampa, FL 33612-7550 |
Second Address | Tampa, FL 33612-7550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2011 |
Last Update Date | 16/08/2011 |