Provider Demographics
NPI:1316110679
Name:FITZGERALD, LEO L JR (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:L
Last Name:FITZGERALD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 FOREST LANE
Mailing Address - Street 2:#180
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042
Mailing Address - Country:US
Mailing Address - Phone:972-494-1419
Mailing Address - Fax:972-494-2069
Practice Address - Street 1:2046 FOREST LANE
Practice Address - Street 2:#180
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042
Practice Address - Country:US
Practice Address - Phone:972-494-1419
Practice Address - Fax:972-494-2069
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7992208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice