Healthcare Provider Details

I. General information

NPI: 1265479646
Provider Name (Legal Business Name): GEORGE A FOURNIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

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 TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME51944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: