Provider Demographics
NPI:1649825290
Name:FITZGERALD, DEREK A (MD)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:A
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8522 BROADWAY STE 216
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6456
Mailing Address - Country:US
Mailing Address - Phone:210-874-5260
Mailing Address - Fax:210-864-4838
Practice Address - Street 1:805 E 32ND ST STE 100-102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2537
Practice Address - Country:US
Practice Address - Phone:210-374-2724
Practice Address - Fax:210-874-8512
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXV9311208VP0014X
DCMTL005789208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty