MEDICARE: DR. JORGE FORTUN MD

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
1	207W00000X	Ophthalmology Physician	BP20023396	TX
2	207W00000X	Ophthalmology Physician	ME107110	FL

General Provider Information

NPI Number	:	1184736464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE FORTUN MD

Provider Business Mailing Address
First Line	:	7101 FAIRWAY DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3701
Country	:	US
Telephone Number	:	561-515-1500
Fax Number	:	561-515-1513

Provider Business Practice Location Address
First Line	:	7101 FAIRWAY DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3701
Country	:	US
Telephone Number	:	561-515-1500
Fax Number	:	561-515-1513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/13/2019

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