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NPI Code Detail

MEDICARE: MR. ROBIN DALE FORTUNE

MEDICARE: MR. ROBIN DALE FORTUNE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZS0410XSurgical TechnologistSA050KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1SA050OTHERKYKBML CERTIFICATION NO.

General Provider Information

NPI Number : 1073668067
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBIN DALE FORTUNE
Provider Business Mailing Address
First Line : 5099 SPORTSMAN LAKE RD
Second Line :
City : ELIZABETHTOWN
State : KY
Zip : 42701-8216
Country : US
Telephone Number : 270-369-8984
Fax Number : 270-369-8562
Provider Business Practice Location Address
First Line : 5099 SPORTSMAN LAKE RD
Second Line :
City : ELIZABETHTOWN
State : KY
Zip : 42701-8216
Country : US
Telephone Number : 270-369-8984
Fax Number : 270-369-8562
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 07/08/2007

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Directions to “ MR. ROBIN DALE FORTUNE ” Practice Location

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