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NPI Code Detail

MEDICARE: DR. JOHN ERIC FORTENBERRY M.D.

MEDICARE: DR. JOHN ERIC FORTENBERRY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianG72510CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083693345
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN ERIC FORTENBERRY M.D.
Provider Business Mailing Address
First Line : 15708 TRADITION CT
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93314-7871
Country : US
Telephone Number : 661-588-0758
Fax Number : 661-588-0758
Provider Business Practice Location Address
First Line : 400 OLD RIVER RD
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93311-9781
Country : US
Telephone Number : 661-326-8021
Fax Number : 661-326-8022
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2006
Last Update Date : 01/07/2013

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