Provider Demographics
NPI:1871517193
Name:FITZGERALD, SHARI J (MD)
Entity type:Individual
Prefix:DR
First Name:SHARI
Middle Name:J
Last Name:FITZGERALD
Suffix:
Gender:F
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:PO BOX 8539
Mailing Address - Street 2:1790B AIRPORT ROAD
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-8539
Mailing Address - Country:US
Mailing Address - Phone:970-453-7600
Mailing Address - Fax:970-453-7688
Practice Address - Street 1:1790 AIRPORT ROAD, #B
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424
Practice Address - Country:US
Practice Address - Phone:970-453-7600
Practice Address - Fax:970-453-7688
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMHSZ196OtherMEDICARE PART B
NM66635357Medicaid
NMK3526Medicaid
NM8HM230OtherPTAN # (MEDICARE)
NMHSZ196OtherMEDICARE PART B
NM320057Medicare Oscar/Certification