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NPI Code Detail

MEDICARE: SIDNEY RAY FORTNEY MD

MEDICARE: SIDNEY RAY FORTNEY 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
1207RE0101XEndocrinology, Diabetes & Metabolism Physician13798NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00399761OTHERNCRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
333170OTHERNCBCBS IND PROV #

General Provider Information

NPI Number : 1417947714
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIDNEY RAY FORTNEY MD
Provider Business Mailing Address
First Line : 8715 E OAK ISLAND DR
Second Line :
City : OAK ISLAND
State : NC
Zip : 28465-8367
Country : US
Telephone Number : 910-278-3316
Fax Number : 910-278-1415
Provider Business Practice Location Address
First Line : 8715 E OAK ISLAND DR
Second Line :
City : OAK ISLAND
State : NC
Zip : 28465-8367
Country : US
Telephone Number : 910-278-3316
Fax Number : 910-278-1415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 03/24/2008

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Directions to “ SIDNEY RAY FORTNEY MD” Practice Location

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