Provider Demographics
NPI:1700675741
Name:FITZGERALD, JOSHUA (CRM)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2928
Mailing Address - Country:US
Mailing Address - Phone:541-429-4940
Mailing Address - Fax:541-429-4941
Practice Address - Street 1:419 SW 5TH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2020
Practice Address - Country:US
Practice Address - Phone:541-429-4940
Practice Address - Fax:541-429-4941
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25-CRM-4390175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist