Provider Demographics
NPI:1871540278
Name:FITCH, DWIGHT L (MD)
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:L
Last Name:FITCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1860 BOY SCOUT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2119
Mailing Address - Country:US
Mailing Address - Phone:239-215-1180
Mailing Address - Fax:239-215-1180
Practice Address - Street 1:5325 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5534
Practice Address - Country:US
Practice Address - Phone:941-220-6263
Practice Address - Fax:864-909-9100
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME00959352085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL363218OtherWELLCARE PROVIDER #
FLOV540OtherMEDICARE
FLOV541OtherMEDICARE
FLME95935OtherMETCARE PROVIDER #
FL276150500Medicaid
FL53040OtherBCBS FL PROVIDER #
FL7229796OtherAETNA PROVIDER #
FL4969206OtherCIGNA PROVIDER #
FLP00348796OtherRAILROAD MEDICARE PIN #