=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447297189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON C FORTNEY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 12/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3119 N 14TH ST
-----------------------------------------------------
City | BISMARCK
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58503-0664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-222-3937
-----------------------------------------------------
Fax | 701-255-3493
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4208 OVERLAND RD
-----------------------------------------------------
City | BISMARCK
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58503-8839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-224-0302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 9372
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------