Fitzgerald, Russell W

Fitzgerald, Russell W is an individual health care provider with primary practice located at 2 Plaza Dr , Liberal KS 67901-2743. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Fitzgerald, Russell W can be contacted via phone (620) 624-5691.

Contact Information

Primary practice address
2 Plaza Dr Liberal KS 67901-2743
Phone: (620) 624-5691
Fax: (620) 624-3656
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 04-27378 Kansas
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 23365 Oklahoma

Profile Details

NPI number 1316914120
LBN Legal business name Fitzgerald, Russell W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 1st, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316914120 NPPES
Kansas Other 101857 BCBS OF KS

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