MEDICARE: DR. RICHARD ALLAN FORT MD

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
1	146D00000X	Personal Emergency Response Attendant	MD00023848	WA

General Provider Information

NPI Number	:	1215902820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ALLAN FORT MD

Provider Business Mailing Address
First Line	:	3822 RIDGEWOOD DR
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-7708
Country	:	US
Telephone Number	:	360-257-9646
Fax Number	:	360-257-9650

Provider Business Practice Location Address
First Line	:	3822 RIDGEWOOD DR
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-7708
Country	:	US
Telephone Number	:	360-257-9646
Fax Number	:	360-257-9650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2006
Last Update Date	:	07/08/2007

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