Healthcare Provider Details

I. General information

NPI: 1639309206
Provider Name (Legal Business Name): GEORGE A FOURNIER III MD FACS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2466 E COMMERCIAL BLVD STE 102
FT LAUDERDALE FL
33308-4011
US

IV. Provider business mailing address

2466 E COMMERCIAL BLVD STE 102
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 Code332H00000X
TaxonomyEyewear Supplier
License NumberME51944
License Number StateFL

VIII. Authorized Official

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