Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A140475 | CA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME153854 | FL |
NPI | 1063702314 |
---|---|
Provider Name | Ryan Everett Fitzgerald |
First Address | Indianapolis, IN 46219-4959 |
Second Address | St Petersburg, FL 33701-4629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 29/12/2021 |