Provider Demographics
NPI:1588738215
Name:FITZGERALD, DANIEL JOSEPH III (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:FITZGERALD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:74075 EL PASEO
Mailing Address - Street 2:STE B-1
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4118
Mailing Address - Country:US
Mailing Address - Phone:760-346-4600
Mailing Address - Fax:760-346-6433
Practice Address - Street 1:74075 EL PASEO
Practice Address - Street 2:STE B-1
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4118
Practice Address - Country:US
Practice Address - Phone:760-346-4600
Practice Address - Fax:760-346-6433
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG870392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB77276Medicare UPIN