Provider Demographics
NPI:1699876870
Name:GITTENS, CARL CARRINGTON FITZGERAL SR (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:CARRINGTON FITZGERAL
Last Name:GITTENS
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:611 SW FEDERAL HWY STE E
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2925
Mailing Address - Country:US
Mailing Address - Phone:772-288-4111
Mailing Address - Fax:772-905-3336
Practice Address - Street 1:611 SW FEDERAL HWY STE E
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2925
Practice Address - Country:US
Practice Address - Phone:772-288-4111
Practice Address - Fax:772-905-3336
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2021-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME53378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048702300Medicaid
FL048702300Medicaid
FLD21154Medicare UPIN