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General NPI Number Information
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NPI Number | 1376563999
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Entity Type | Individual
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Provider Name | RICHARD FORTNEY P.A
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 2060 W 24TH ST
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City | YUMA
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State | AZ
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Zip | 85364-6123
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Country | US
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Telephone | 928-539-3082
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Fax | 928-539-5579
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Provider Business Mailing Address
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Address Line | 2060 W 24TH ST
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City | YUMA
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State | AZ
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Zip | 85364-6123
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Country | US
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Telephone | 928-539-3082
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Fax | 928-539-5579
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1549
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License Number State | AZ
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