Healthcare Provider Details

I. General information

NPI: 1336431758
Provider Name (Legal Business Name): ALEXANDER FORT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE C-300
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE C-300
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1446
  • Fax: 305-585-7094
Mailing address:
  • Phone: 305-585-1446
  • Fax: 305-585-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberME128413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: