Provider Demographics
NPI:1538193867
Name:FITZGIBBONS, LORI A (PAC)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:FITZGIBBONS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7335 S PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4571
Mailing Address - Country:US
Mailing Address - Phone:303-979-7200
Mailing Address - Fax:303-933-5265
Practice Address - Street 1:7335 S PIERCE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4571
Practice Address - Country:US
Practice Address - Phone:303-979-7200
Practice Address - Fax:303-933-5265
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA047207Q00000X
COPA.0003441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine