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General NPI Number Information
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NPI Number | 1811202328
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Entity Type | Organization
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Legal Business Name | LAWRENCEJFORTUNAMDPA
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 718 E MCNAB RD
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City | POMPANO BEACH
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State | FL
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Zip | 33060-9430
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Country | US
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Telephone | 954-876-0945
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Fax | 954-876-0965
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Provider Business Mailing Address
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Address Line | 718 E MCNAB RD
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City | POMPANO BEACH
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State | FL
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Zip | 33060-9430
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Country | US
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Telephone | 954-876-0945
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Fax | 954-876-0965
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. LAWRENCE JOSEPH FORTUNA
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Credential | MD
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Telephone | 954-876-0945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ME46908
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License Number State | FL
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