Provider Demographics
NPI:1972502649
Name:FITCH, JOHN THOMAS JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:FITCH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7959 BROADWAY ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2667
Mailing Address - Country:US
Mailing Address - Phone:210-826-1891
Mailing Address - Fax:210-826-4335
Practice Address - Street 1:7959 BROADWAY ST
Practice Address - Street 2:SUITE 604
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2667
Practice Address - Country:US
Practice Address - Phone:210-826-1891
Practice Address - Fax:210-826-4335
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK8152208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80821XOtherBLUE CROSS BLUE SHIELD
TX5805700OtherAETNA