MEDICARE: GEORGE A FOURNIER III MD FACS PA

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	332H00000X	Eyewear Supplier	ME51944	FL

General Provider Information

NPI Number	:	1639309206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE A FOURNIER III MD FACS PA

Provider Business Mailing Address
First Line	:	2466 E COMMERCIAL BLVD
Second Line	:	STE 102
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4011
Country	:	US
Telephone Number	:	954-492-1177
Fax Number	:	954-492-0352

Provider Business Practice Location Address
First Line	:	2466 E COMMERCIAL BLVD
Second Line	:	STE 102
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4011
Country	:	US
Telephone Number	:	954-492-1177
Fax Number	:	954-492-0352

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE A FOURNIER III
Credential	:	MD
Telephone Number	:	954-492-1177

Provider Enumeration Date	:	07/17/2009
Last Update Date	:	12/28/2009

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