Provider Demographics
NPI:1871987784
Name:FITZPATRICK, JESSE KEISER (MD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:KEISER
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LAWRENCE EXPRESSWAY
Mailing Address - Street 2:DEPT 348
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-0119
Mailing Address - Country:US
Mailing Address - Phone:408-851-3355
Mailing Address - Fax:408-851-3331
Practice Address - Street 1:710 LAWRENCE EXPRESSWAY
Practice Address - Street 2:DEPT 348
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-0119
Practice Address - Country:US
Practice Address - Phone:408-851-3355
Practice Address - Fax:408-851-3331
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-28
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA146260207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program