Basic Information
| Provider Information | |||||||||
| NPI: | 1093158685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITZGERALD | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | CASEY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100237 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522735159 | ||||||||
| FaxNumber: | 3522735213 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326109595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525420068 | ||||||||
| FaxNumber: | 3525421843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2013 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 191427 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 2016-00466 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | ME134163 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.