Provider Demographics
NPI:1588742001
Name:FITZPATRICK, PHILIP CLARK III (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:CLARK
Last Name:FITZPATRICK
Suffix:III
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 1:801 WILLIAM AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6556
Mailing Address - Country:US
Mailing Address - Phone:308-532-3330
Mailing Address - Fax:308-532-3334
Practice Address - Street 1:801 WILLIAM AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101
Practice Address - Country:US
Practice Address - Phone:308-532-3330
Practice Address - Fax:308-532-3334
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21635207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE35296OtherBLUE CROSS BLUE SHIELD
NE47084139713Medicaid
NE35296OtherBLUE CROSS BLUE SHIELD
H41513Medicare UPIN