Healthcare Provider Details

I. General information

NPI: 1649218645
Provider Name (Legal Business Name): GEORGE A FOURNIER III, M.D., F.A.C.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2466 E COMMERCIAL BLVD
FT LAUDERDALE FL
33308-4011
US

IV. Provider business mailing address

2466 E COMMERCIAL BLVD
FT LAUDERDALE FL
33308-4011
US

V. Phone/Fax

Practice location:
  • Phone: 954-492-1177
  • Fax: 954-492-0352
Mailing address:
  • Phone: 954-492-1177
  • Fax: 954-492-0352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC1584
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME51944
License Number StateFL

VIII. Authorized Official

Name: DR. GEORGE A FOURNIER III
Title or Position: PRESIDENT
Credential: MD
Phone: 954-492-1177